• Bryan Zheng, Owen P Leary, Robert A Beer, David D Liu, Sarah Nuss, Adriel Barrios-Anderson, Spencer Darveau, Sohail Syed, Ziya L Gokaslan, Albert E Telfeian, Adetokunbo A Oyelese, and Jared S Fridley.
• Department of Neurosurgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA. Electronic address: bryan_zheng@brown.edu.
• World Neurosurg. 2023 Feb 1; 170: e568e576e568-e576.

BackgroundAlthough lateral lumbar interbody fusion (LLIF) is an effective surgical option for lumbar arthrodesis, postoperative plexopathies are a common complication. We characterized post-LLIF plexopathies in a large cohort and analyzed potential risk factors for each.MethodsA single-institutional cohort who underwent LLIF between May 2015 and December 2019 was retrospectively reviewed for postoperative lumbar plexopathies. Plexopathies were divided based on sensory and motor symptoms and duration, as well as by laterality relative to the surgical approach. We assessed these subgroups for associations with patient and surgical characteristics as well as psoas dimensions. We then evaluated risk of developing plexopathies after intraoperative neuromonitoring observations.ResultsA total of 127 patients were included. The overall rate of LLIF-induced sensory or motor lumbar plexopathy was 37.8% (48/127). Of all cases, 42 were ipsilateral to the surgical approach (33.1%); conversely, 6 patients developed contralateral plexopathies (4.7%). Most (31/48; 64.6%) resolved with a follow-up interval of 402 days in the plexopathy group. Of ipsilateral cases, 24 patients experienced persistent (>90 days) postoperative sensory symptoms (18.9%), whereas 20 experienced persistent weakness (15.7%). More levels fused predicted persistent sensory symptoms (odds ratio, 1.714 [1.246-2.359]; P = 0.0085), whereas surgical duration predicted persistent weakness (odds ratio, 1.004 [1.002-1.006]; P = 0.0382). Psoas anatomic variables were not significantly associated with plexopathy. Nonresolution of intraoperative evoked motor potential alerts was a significant risk factor for developing plexopathies (relative risk, 2.29 [1.17-4.45]).ConclusionsPost-LLIF plexopathies are common but usually resolve. Surgical complexity and unresolved neuromonitoring alerts are possible risk factors for persistent plexopathy.Copyright © 2022 Elsevier Inc. All rights reserved.

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