Lateral Lumbar Interbody Fusion (LLIF) Procedure with Quad Changes and Resolution During Retractor Placement
By Admin | July 03, 2024
Imagine experiencing seemingly endless chronic lower back pain. In this condition, even simple tasks like bending over or getting out of a chair are a struggle. The only thing that seems to bring you any sort of relief is laying down. Now add on that you’ve already undergone surgery for this once before. What would your state-of-mind be?
This was the reality for a 38-year-old woman who underwent a minimally invasive spinal surgery called Lateral Lumbar Interbody Fusion (LLIF). While minimally invasive surgeries like this offer numerous benefits, there's always a risk of complications. However, through the use of intraoperative neuromonitoring, it’s possible to reduce the risk of such complications.
Following a surgery 10 months prior, our patient was experiencing worsening lower back pain, particularly when bending over or rising from a seated position. This pain made daily activities challenging. X-rays revealed worsening degeneration of the disc between the L4 and L5 vertebrae. To address this, the surgeon opted for an LLIF procedure at the L4-L5 level, with additional minimally invasive fusion techniques on the back (posterior) of the spine.
LLIF is a surgical approach used to treat disc problems in the lower back. Discs act as cushions between the vertebrae, providing flexibility and absorbing shock. When these discs degenerate due to wear and tear, pain and stiffness can occur. Through a small incision on the side (lateral) of the spine and the placement of a spacer (cage) between the vertebrae to create space, surgeons are able to alleviate pressure on nerves, and promote stability. While this minimally invasive approach typically allows patients to go home the same day as the surgery, no surgery is without risk of complications. In the case of LLIF, postoperative complications are rare but can include thigh weakness or pain, injury to abdominal organs or nerves to lower extremities, and/or the failure of vertebrae to fuse due to hardware issues or settling of bone graft.
During the Lateral Lumbar Interbody Fusion procedure, intraoperative neuromonitoring played a critical role by continuously tracking the function of nerves throughout the surgery. In this patient's case, during the placement of the cage between the L4 and L5 vertebrae, a significant decrease in activity in the muscles of the left quadricep (thigh) was detected. The decrease in this signal, called a Motor Evoked Potential (MEP), indicated nerve irritation.
The surgeon was immediately alerted to this change in nerve activity and because of this early warning, the surgeon was able to take the necessary precautions to minimize further nerve irritation. After the surgeon adjusted their approach and placed the cage, nerve activity in the left quadriceps returned to normal and remained stable for the rest of the procedure.
Without neuromonitoring, the decreased nerve activity might have gone unnoticed. This could have led to postoperative complications such as weakness or numbness in the left leg, significantly impacting the patient's mobility and recovery. Neuromonitoring provides real-time feedback on nerve function during surgery and allows the surgical team to make adjustments and minimize the risk of nerve injury and other postoperative complications.
This case highlights the transformative power of neuromonitoring in improving patient outcomes. For more information on the transformative benefits of neuromonitoring, please contact us at 888-344-2947.
