Citation: Journal of Clinical Neuroscience. 61:124-129, 2019 Mar..Journal: Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia.Published: ; ; ; 2019ISSN: 0967-5868.Full author list: Mueller K; McGowan J; Kane S; Voyadzis JM.UI/PMID: 30552048.Subject(s): Adult | Aged | Female | *Femoral Nerve/in [Injuries] | Humans | Lumbar Vertebrae/su [Surgery] | Male | Middle Aged | Muscle Weakness/ep [Epidemiology] | *Muscle Weakness/et [Etiology] | Postoperative Complications/ep [Epidemiology] | *Postoperative Complications/et [Etiology] | Retrospective Studies | *Spinal Fusion/ae [Adverse Effects] | Spinal Fusion/mt [Methods]Institution(s): MedStar Washington Hospital CenterDepartment(s): NeurosurgeryActivity type: Journal Article.Medline article type(s): Journal ArticleDigital Object Identifier: https://dx.doi.org/10.1016/j.jocn.2018.10.108 (Click here)Abbreviated citation: J Clin Neurosci. 61:124-129, 2019 Mar.Abstract: BACKGROUND: Complications associated with the lateral lumbar transpsoas approach largely comprise various nerve-related syndromes particularly at L4-5. Quadriceps weakness can occur from stretch injury to the femoral nerve during retraction.Abstract: OBJECTIVE: The purpose of this study is to evaluate the role of retraction time in the development of postoperative neuropathic motor weakness at the L4-5 level.Abstract: METHODS: A retrospective review of a prospectively collected database at a single institution was reviewed over a two-year period (March 2014-2016) for a single surgeon. Twenty-six patients undergoing single level LLIF at L4-5 were identified. Pre- and postoperative data collection obtained included motor function grading (0-5/5) with a minimum of 3-month postoperative follow-up. Intraoperative data collection included retraction time (RT) defined as the time the retraction system was affixed to the spine and expanded to the time of closure and removal. Two-Tailed T-Test was used to determine clinical significance.Abstract: RESULTS: 50% of patients had leg weakness after surgery (13/26). All postoperative motor deficits were at least antigravity strength (>3/5) and all deficits resolved. The mean RT for the motor dysfunction cohort was 29min (14-51) compared to 27.5min for the cohort without postoperative weakness (19-37) (p=0.685).Abstract: CONCLUSION: The results of this study suggest that longer retraction time (within a range of 14-51min) did not correlate with a greater risk of postoperative neuropathic quadriceps muscle dysfunction for lateral lumbar interbody fusions performed at L4-5. Other factors may contribute to postoperative neurologic dysfunction regardless of RT. Motor deficits resolved quickly after surgery.Abstract: Copyright (c) 2018 Elsevier Ltd. All rights reserved.