Vulnerability of the femoral nerve during complex anterior and posterior spinal surgery

Swetha Naroji, Laurence J Belin, Mitchell Gil Maltenfort, Alexander R Vaccaro, Daniel Schwartz, James S Harrop, Michael Weinstein
Journal of Spinal Cord Medicine 2009, 32 (4): 432-5

BACKGROUND: Femoral nerve palsy is not a common adverse effect of lumbar spinal surgery.

OBJECTIVE: To report 3 unique cases of femoral nerve neuropathy due to instrumentation and positioning during complex anterior and posterior spinal surgery.

METHODS: Case series

RESULTS: All 3 patients demonstrated femoral nerve neuropathy. The first patient presented postoperatively but after 6 months, the palsy resolved. Femoral nerve malfunctioning was documented in the second and third patients intraoperatively; however, with rapid patient repositioning and removal of offending instrumentation, postoperative palsy was avoided.

CONCLUSIONS: Use of motor evoked potential monitoring of the femoral nerve during surgery is vital for the prevention of future neuropathies, an avoidable complication of spinal surgery.

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