Retraction Time per Level in Relation to Post Operative Leg Pain Following Extreme Lateral Interbody Fusion

Presented at SMISS Annual Forum 2013
By Jim Youssef MD
With Douglas Orndorff MD, Morgan Scott , Rachel Ebner ,

Disclosures: Jim Youssef MD A; Spinal Research Foundation, NuVasive, BioSurface Engineering Technologies, Globus Medical, ARTM, Axial Biotech, Vertiflex, Integra. B; NuVasive, Integra, Amedica. D; Amedica, Pioneer, Vertiflex, Be Douglas Orndorff MD A; Globus Medical, SeaSpine, Vertiflex, Nuvasive. B; Nuvasive, SeaSpine, Stryker. F; SeaSpine., Morgan Scott None, Rachel Ebner None,

Background: Evidence for the use of XLIF as an effective treatment for spinal disorders is increasing in popularity. However, postoperative leg pain and/or dysesthesia are a potential complication of this procedure. We report on the incidence of postoperative leg pain and correlation with intra-operative retraction times recorded during surgery following XLIF.

Purpose: This single site investigational study has been conducted to report the relationship between retraction time and postoperative leg pain and/or dysesthesia following XLIF procedures.
Patient Sample: Retraction time and postoperative leg pain reports were collected for 49 patients with a total of 84 operative levels whom underwent an XLIF procedure.

Outcomes Measures: Retraction times were collected intraoperatively, while the postoperative leg pain was patient reported at 2-week, 6-week and 1-year follow up visits.

Methods: Local IRB approved prospective, non-randomized single center study review of 49 patients with a total of 84 operative levels, mean age of 62.6 yrs (24-77), from Feb 2011- Jul 2013. Patient-reported postoperative leg pain and/or dysesthesia (numbness, quadriceps weakness, leg spasms, anterior thigh, lateral leg, and hip pain) categorized as either motor or sensory deficit was noted at 2-weeks for 48 patients (83 levels), 6-weeks for 42 patients (76 levels), 1-year for 19 patients (32 levels).

Results: Average retraction time in minutes per level was recorded as 22 min for T12-L1, 18.5min at L1-2, 23.2 min at L2-3, 23.31min at L3-4 and 24.2 min at L4-5. At the 2-week follow-up, 8/48 patients (16.6%) reported sensory deficits, and 15/48 patients (31.2%) reported motor deficits. At 6-weeks, 5/42 patients (11.9%) reported sensory deficits and 7/42 patients (16.6%) reported motor. At 1-year, 1/19 patients (5.3%) continued to report motor deficits.

Conclusion: Our study reports resolution of 88% of postoperative leg pain by 3-months. Of those that experienced sensory or motor deficits, 9/10 patients (90%) reported resolution by 1-year follow-up. Patient reported motor deficits when present were noted at all levels except T12-L1, while no sensory deficits were found in those patients fused at either T12-1 or L1-2. Postoperative leg symptoms appear to be approach related, possibly due to retraction time yet remain self limiting following XLIF. We anticipate reporting on further follow-up of postoperative leg pain when all patients achieve longer follow-up.