Case Report on Contralateral Neural Complications following OLIF

Area of Science:

• Neurosurgery
• Orthopedic Surgery
• Spinal Fusion Techniques

Background:

• Oblique Lumbar Interbody Fusion (OLIF) is a common minimally invasive technique for lumbar degenerative diseases.
• Neurological complications of OLIF typically involve the ipsilateral lumbar plexus.
• Contralateral L4 nerve root compression is an exceptionally rare complication with poorly understood mechanisms.

Purpose of the Study:

• To report a rare case of contralateral L4 nerve root compression following OLIF.
• To elucidate the biomechanical mechanisms and radiological findings associated with this complication.
• To emphasize preventive strategies and management of this rare complication.

Main Methods:

• A case report of a 61-year-old female patient undergoing L3/4 and L4/5 OLIF.
• Postoperative imaging (CT/MRI) to identify the cause of neurological deficits.
• Revision surgery using transforaminal lumbar interbody fusion (TLIF) for decompression.

Main Results:

• The patient developed right lower extremity pain and quadriceps weakness post-OLIF.
• Imaging revealed a malpositioned interbody cage and fractured osteophyte fragment compressing the contralateral L4 nerve root.
• Revision surgery successfully decompressed the nerve, leading to complete symptom resolution at 5-month follow-up.

Conclusions:

• Contralateral L4 nerve root compression can result from cage malposition and osteophyte fracture during OLIF.
• Precise surgical technique, fluoroscopic verification, and patient positioning are crucial for prevention.
• Prompt diagnosis and revision surgery are effective in managing this rare complication, ensuring functional recovery.