*Sektion für Wirbelsäulenchirurgie, Centrum für Muskuloskeletale Chirurgie, Charité-Universitätsmedizin Berlin, Berlin, Germany; and †Department of Orthopaedic Surgery, Spine and Scoliosis Service, Hospital for Special Surgery, New York, NY.
Spine (Phila Pa 1976). 2013 Oct 15;38(22):1959-63. doi: 10.1097/BRS.0b013e3182a463a9.
Retrospective case series.
To report on the rare finding of motor deficits contralateral to the transpsoas approach in patients who underwent lateral lumbar interbody fusion (LLIF).
Although sensorimotor deficits occurring ipsilaterally to a transpsoas approach have more fully been elucidated, there seems to be a paucity of data on motor deficits contralateral to an LLIF approach.
The electronic medical records and radiographical studies of 244 patients who underwent LLIF at a single institution between 2006 and 2009 were retrospectively reviewed for reports on motor deficits contralateral to the surgical approach.
Of the patients reviewed, 2.9% (7/244) presented with a postoperative contralateral motor deficit, the most severe of which was a 1/5 weakness of the quadriceps muscle. An average of 3 levels (range: 2-4) was fused in 7 patients who developed a contralateral motor deficit, and in 3 of the 7 patients, an anterior lumbar interbody fusion (ALIF) was performed in addition to the LLIF. At 1 year follow-up, 3 patients presented with complete resolution of their muscle weakness, 1 patient still had mild weakness, 1 patient had decreased range of motion in the affected joint, and 1 patient had a 2/5 foot drop. One patient was lost to follow-up.
These data are among the largest reports of contralateral motor deficits after LLIF. Among possible underlying mechanisms are entrapment of the contralateral nerve root through translational correction of spondylolisthesis, front-to-back misalignment of the cage resulting in contralateral nerve root impingement, pressure on the contralateral peroneal nerve during positioning, and overdistraction neurapraxia when using ALIF at L5-S1 concomitantly. Awareness of the possibility of this rare complication can play an important role in surgical consideration and preoperative patient counseling.
回顾性病例系列研究。
报告接受腰椎侧方椎间融合术（LLIF）患者中，经椎间孔入路对侧运动功能障碍的罕见发现。
虽然对经椎间孔入路同侧发生的感觉运动功能障碍有更充分的阐述，但关于 LLIF 入路对侧运动功能障碍的数据似乎很少。
回顾性分析 2006 年至 2009 年在一家机构接受 LLIF 的 244 例患者的电子病历和影像学研究，以报告手术入路对侧的运动功能障碍。
在接受评估的患者中，2.9%（7/244）出现术后对侧运动功能障碍，其中最严重的是股四头肌肌力 1/5 级。在出现对侧运动功能障碍的 7 例患者中，平均融合 3 个节段（范围：2-4 个节段），其中 3 例患者除 LLIF 外还进行了前路腰椎椎间融合术（ALIF）。在 1 年随访时，3 例患者的肌肉无力完全缓解，1 例仍有轻度无力，1 例受累关节活动度减小，1 例出现足下垂 2/5 级。1 例患者失访。
这些数据是关于 LLIF 后对侧运动功能障碍的最大报告之一。可能的潜在机制包括：通过对滑脱的平移矫正使对侧神经根受压；椎间笼的前后错位导致对侧神经根受压；定位时对腓总神经的压迫；同时在 L5-S1 行 ALIF 时过度牵伸导致神经失用。对这种罕见并发症发生可能性的认识可以在手术考虑和术前患者咨询中发挥重要作用。
4 级。
