Contralateral lumbar plexopathy after minimally invasive transforaminal lumbar interbody fusion: A case report

Abstract

Introduction: Minimally Invasive Transforaminal Lumbar Interbody Fusion (MI-TLIF) is an effective treatment for patients with degenerative lumbar spinal disease. This modality was devised to reduce approach-related morbidity and complications of open TLIF. Materials and methods: In this report, we describe a unique case of a 40-year-old woman who developed contralateral lumbar plexopathy one day after the MI-TLIF procedure. Results: Postoperative Computed Tomography (CT) and MRI showed a left L4 transverse process fracture compressing the psoas muscle, and the lumbosacral fascia and erector spinae muscles were displaced forward. We performed fractured left L4 transverse process bone fragment removal to decompress the psoas muscle and correct the original place of the left lumbar fascia and erector spinae muscles. One month after reoperation, the patient had gradual alleviation of pain; leg weakness also recovered enough to enable locomotion. Conclusions: In our case, MI-TLIF relieved lower back and right leg pain. However, the patient developed left radicular leg pain with weakness. There was displacement of the lumbosacral fascia and erector spinae muscles. These problems induced displacement of the psoas muscle with compression, which resulted in lumbar plexopathy. If skin incisions are not enough to carry further down through the subcutaneous tissue and the underlying fascia, displacement of both the left lumbosacral fascia and erector muscles can occur while inserting the pedicle screws. Therefore, it is important to make an incision from the skin to the underlying fascia and surgical corridors to insert the pedicle screws during MI-TLIF. Keywords: transforaminal lumbar interbody fusion; plexopathy; pedicle screw.