Pennicooke Brenton, Guinn Jeremy, Chou Dean
Department of Neurological Surgery, University of California, San Francisco, San Francisco, California.
J Neurosurg Case Lessons. 2021 Jul 5;2(1):CASE21210. doi: 10.3171/CASE21210.
While performing lateral lumbar interbody fusion surgery, one of the surgical goals is to release the contralateral side with a Cobb elevator, allowing distraction of the interbody space. Many times, there are large osteophytes on the contralateral side, and the osteophytes can be split open with the Cobb or blunt instrument. It is extremely rare for the actual osteophyte to break off from the vertebral body into the contralateral psoas muscle and lumbar plexus.
The authors report a case of symptomatic lumbar plexopathy caused by an osteophyte fracture after an oblique lumbar interbody fusion requiring a right-sided anterior approach to excise the bony fragment. They illustrate the case with imaging that the radiologist did not comment on, and they also show a video of the surgical excision of the osteophyte through a right-sided anterior lumbar retroperitoneal approach. The authors also show how the patient had spontaneous right-sided electromyography (EMG) firing before excision of the osteophyte and how the EMG firing resolved after excision.
Although the literature is plentiful with regard to ipsilateral approach-related complications, the authors discuss the literature with regard to contralateral complications after minimally invasive lateral lumbar interbody fusion.
在进行腰椎侧方椎间融合手术时，手术目标之一是用 Cobb 骨膜剥离子松解对侧，以撑开椎间间隙。很多时候，对侧会有大的骨赘，这些骨赘可用 Cobb 骨膜剥离子或钝性器械劈开。实际的骨赘从椎体脱落进入对侧腰大肌和腰丛极为罕见。
作者报告了 1 例在斜外侧腰椎椎间融合术后因骨赘骨折导致有症状的腰丛病变的病例，该病例需要经右侧前路切除骨块。他们展示了放射科医生未提及的影像学资料来阐述该病例，还展示了经右侧前路腰椎腹膜后入路手术切除骨赘的视频。作者还展示了患者在骨赘切除前右侧肌电图（EMG）有自发放电，以及切除后 EMG 放电如何消失。
尽管关于同侧入路相关并发症的文献很多，但作者讨论了微创腰椎侧方椎间融合术后对侧并发症的文献。
