Lumbar nerve root palsy after adult spinal deformity surgery

A retrospective study was conducted to investigate the incidence and prognosis of postoperative lumbar nerve root palsy after surgical treatment for adult spinal deformity.

To decipher the incidence of postoperative lumbar nerve root palsy and recovery in 361 adult spinal deformity patients who underwent 407 spinal fusion surgeries.

Although lumbar nerve root palsy is a known complication of spinal surgery, there are no large studies that have examined its incidence or prognosis.

Three hundred and sixty-one consecutive patients who underwent 407 procedures for adult deformity spinal surgery were reviewed. Patients in this study did not have spinal cord injury or nerve root compression on the postoperative imaging study (obtained for change in neurologic examination). The incidence of nerve root palsy was based on postoperative muscle strength, which was followed for a minimum of 3 and an average of 7 years.

The overall incidence of lumbar nerve root palsy was 2.9% with a 1.4% incidence in primary and 3.8% incidence in revision surgery. The incidence was 0.9, 1.5, and 7.4% for fusion of <5 levels, 5 to 10 levels, and >10 levels, respectively. The incidence of nerve root palsy for posterior only, same day anterior-posterior, and staged posterior was 1.3, 3, and 7.2%, respectively. While L5 was the most commonly injured nerve root, all other lumbar nerve roots were also involved. There were no S1 injuries. Although there was some recovery in most injuries, Grade IV injuries had the best recovery at 1-year follow-up.

Patients with increasingly complex spinal deformities are at a higher risk for postoperative lumbar nerve root palsy. These injuries can be treated nonoperatively when there is no identifiable cause on postoperative imaging studies.