Saphenous somatosensory-evoked potentials monitoring of femoral nerve health during prone transpsoas lateral lumbar interbody fusion.
Femoral nerve
LLIF
Lumbar plexus
PTP
Quadriceps palsy
Journal
European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society
ISSN: 1432-0932
Titre abrégé: Eur Spine J
Pays: Germany
ID NLM: 9301980
Informations de publication
Date de publication:
07 2022
07 2022
Historique:
received:
06
03
2021
accepted:
12
04
2022
revised:
30
12
2021
pubmed:
10
5
2022
medline:
7
7
2022
entrez:
9
5
2022
Statut:
ppublish
Résumé
To assess whether saphenous somatosensory-evoked potentials (saphSSEP) monitoring may provide predictive information of femoral nerve health during prone lateral interbody fusion (LIF) procedures. Intraoperative details were captured prospectively in consecutive prone LIF surgeries at a single institution. Triggered electromyography was used during the approach; saphSSEP was monitored throughout using a novel system that enables acquisition of difficult signals and real-time actionable feedback facilitating intraoperative intervention. Postoperative neural function was correlated with intraoperative findings. Fifty-nine patients (58% female, mean age 64, mean BMI 32) underwent LIF at 95 total levels, inclusive of L4-5 in 76%, fixated via percutaneous pedicle screws (81%) or lateral plate, with direct decompression in 39%. Total operative time averaged 149 min. Psoas retraction time averaged 16 min/level. Baseline SSEPs were unreliable in 3 due to comorbidities in 2 and anesthesia in 1; one of those resulted in transient quadriceps weakness, fully recovered at 6 weeks. In 25/56, no saphSSEP changes occurred, and none had postoperative femoral nerve deficits. In 24/31 with saphSSEP changes, responses recovered intraoperatively following intervention, with normal postoperative function in all but one with delayed quadriceps weakness, improved at 4 months and recovered at 9 months, and a second with transient isolated anterior thigh numbness. In the remaining 7/31, saphSSEP changes persisted to close, and resulted in 2 transient isolated anterior thigh numbness and 2 combined sensory and motor femoral nerve deficits, both resolved at between 4 and 8 months. SaphSSEP was reliably monitored in most cases and provided actionable feedback that was highly predictive of neurological events during LIF. Diagnostic: individual cross-sectional studies with consistently applied reference standard and blinding.
Identifiants
pubmed: 35532816
doi: 10.1007/s00586-022-07224-9
pii: 10.1007/s00586-022-07224-9
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1658-1666Informations de copyright
© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.
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