• Fadi Taher, Alexander P Hughes, Darren R Lebl, Andrew A Sama, Matthias Pumberger, Alexander Aichmair, Russel C Huang, Frank P Cammisa, and Federico P Girardi.
• *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. 2013 Oct 15;38(22):1959-63.

Study DesignRetrospective case series.ObjectiveTo report on the rare finding of motor deficits contralateral to the transpsoas approach in patients who underwent lateral lumbar interbody fusion (LLIF).Summary Of Background DataAlthough 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.MethodsThe 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.ResultsOf 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.ConclusionThese 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.Level Of Evidence4.

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