Thoracolumbar Deformity MIS (Palsy) Surgery Complication

Minimally invasive surgical (MIS) techniques have become increasingly popular methods of treating spinal pathologies. Spinal surgeons once trained in traditional open approaches must now familiarize themselves with the complication profile associated with these less invasive techniques. Quadriceps palsy is recognized as a possible adverse event following lateral lumbar interbody fusion (LLIF). The complication occurs due to neurological insults incurred during dissection of the psoas, a muscle that houses key elements of the lumbosacral plexus. Quadriceps palsy is associated with significant morbidity and delayed recovery postoperatively. The chapter gives a brief overview of adult spinal deformity (ASD) including management strategies for treating the disorder. A case of quadriceps palsy is presented in a patient that underwent multilevel LLIF for treatment of ASD. Quadriceps palsy is described in depth including possible causes, presentation in the literature, and common management strategies. Finally, the chapter provides general recommendations for avoiding quadriceps palsy in ASD cases.