• Toshiyuki Shirahata, Ichiro Okano, Stephan N Salzmann, Oliver C Sax, Jennifer Shue, Andrew A Sama, Frank P Cammisa, Tomoaki Toyone, Katsunori Inagaki, Alexander P Hughes, and Federico P Girardi.
• Spine Care Institute, Hospital for Special Surgery, New York, New York, USA; Department of Orthopedic Surgery, Showa University School of Medicine, Tokyo, Japan. Electronic address: tahs.s2003@gmail.com.
• World Neurosurg. 2020 Feb 1; 134: e885-e891.

BackgroundLateral lumbar interbody fusion (LLIF) has often been associated with postoperative lumbar plexus symptoms, including pain, paresthesia, and motor deficits in the lower extremities, especially the anterior thigh regions. Previous studies have suggested that LLIF procedures at L4-L5 will be associated with a greater motor deficit rate than other levels. However, it is unclear which level has the greatest risk of pain and paresthesia. The purpose of the present retrospective observational study was to investigate the difference in the incidence of early postoperative thigh symptoms (pain and paresthesia) stratified by procedure level among patients who had undergone standalone LLIF.MethodsWe reviewed the data from consecutive patients who had undergone LLIF at a single academic institution. A total of 285 standalone LLIF cases without preoperative motor deficits were identified. The incidence of postoperative thigh pain and paresthesia at the 6-week postoperative follow-up examination was assessed at all levels from T12-L1 to L4-L5.ResultsA total of 81 patients (28.4%) had anterior thigh pain and 62 (21.8%) had anterior thigh paresthesia. The presence of ≥3 levels fused (odds ratio [OR], 2.96; P = 0.004) and surgery at L2-L3 (OR, 2.59; P = 0.001) were significant risk factors for postoperative anterior thigh paresthesia on univariate analysis but were not associated with anterior thigh pain. Multivariate analyses demonstrated that only surgery L2-L3 was an independent risk factor for anterior thigh paresthesia (OR, 2.09; P = 0.049).ConclusionsOur results have demonstrated that standalone LLIF at the L2-L3 was significantly associated with a greater incidence of postoperative anterior thigh paresthesia but that the incidence of postoperative thigh pain showed no significant association with any operative level.Copyright © 2019 Elsevier Inc. All rights reserved.

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