The Association between Surgical Level and Early Postoperative Thigh Symptoms among Patients Undergoing Standalone Lateral Lumbar Interbody Fusion (LLIF).

November 18, 2019

BACKGROUND:

LLIF is often associated with postoperative lumbar plexus symptoms, including pain, paresthesia, and motor deficits in the lower extremities, especially in the anterior thigh regions. Previous studies suggest that LLIF procedures at L4/5 are associated with a higher motor deficit rate than other levels, but it is unclear which level is at the highest risk for pain and paresthesia.

OBJECTIVE:

The purpose of this retrospective observational study is to investigate the difference in the incidence of early postoperative thigh symptoms (pain and paresthesia) by procedure level among patients who underwent a standalone lateral lumbar interbody fusion (LLIF) procedure.

METHODS:

We reviewed the data of consecutive patients who underwent LLIF at a single academic institution. 285 standalone LLIF cases without preoperative motor deficits were identified. The incidences of postoperative thigh pain and paresthesia at 6-week postoperative follow-up were assessed in all levels between T12/L1 and L4/5.

RESULTS:

81 patients (28.4%) had anterior thigh pain and 62 patients (21.8%) had anterior thigh paresthesia. Three or more levels fused (OR 2.96, p=0.004) and surgery at L2/3 (OR 2.59, p=0.001) were significant risk factors for postoperative anterior thigh paresthesia in univariate analysis, but were not associated with anterior thigh pain. Multivariate analyses demonstrated that only L2/3 was an independent risk factor for anterior thigh paresthesia (OR 2.09, p=0.049).

CONCLUSIONS:

Our results demonstrated that a standalone LLIF procedure at L2/3 was significantly associated with a higher incidence of postoperative anterior thigh paresthesia and postoperative thigh pain showed no significant association with any operative levels.