{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,6]],"date-time":"2025-11-06T12:22:37Z","timestamp":1762431757544},"reference-count":8,"publisher":"Scientific Scholar","content-domain":{"domain":["surgicalneurologyint.com"],"crossmark-restriction":true},"short-container-title":[],"abstract":"<jats:sec id=\"st1\">\n<jats:title>Background:<\/jats:title>\n<jats:p>Extreme lateral interbody fusions (XLIF) and Minimally Invasive (MIS) XLIF pose significant risks of neural injury to the; lumbar plexus, ilioinguinal, iliohypogastric, genitofemoral, lateral femoral cutaneous, and subcostal nerves. To limit these injuries, many intraoperative neural monitoring (IONM) modalities have been proposed.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"st2\">\n<jats:title>Methods:<\/jats:title>\n<jats:p>Multiple studies document various frequencies of neural injuries occurring during MIS XLIF\/XLIF: plexus injuries (13.28%); sensory deficits (0-75%; permanent 62.5%); motor deficits (0.7-33.6%; most typically iliopsoas weakness (14.3%-31%)), and anterior thigh\/groin pain (12.5-25%.-34%). To avoid\/limit these injuries, multiple IONM techniques have been proposed. These include; using finger electrodes during operative dissection, employing motor evoked potentials (MEP), eliminating (no) muscle relaxants (NMR), and using \u201ctriggered\u201d EMGs.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"st3\">\n<jats:title>Results:<\/jats:title>\n<jats:p>In one study, finger electrodes for XLIF at L4-L5 level for degenerative spondylolisthesis reduced transient postoperative neurological symptoms from 7 [38%] of 18 cases (e.g. without IONM) to 5 [14%] of 36 cases (with IONM). Two series showed that motor evoked potential monitoring (MEP) for XLIF reduced postoperative motor deficits; they, therefore, recommended their routine use for XLIF. Another study demonstrated that eliminating muscle relaxants during XLIF markedly reduced postoperative neurological deficits\/thigh pain by allowing for better continuous EMG monitoring (e.g. NMR no muscle relaxants). Finally, a \u201ctriggered\u201d EMG study\u201d reduced postoperative motor neuropraxia, largely by limiting retraction time.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"st4\">\n<jats:title>Conclusion:<\/jats:title>\n<jats:p>Multiple studies have offered different IONM techniques to avert neurological injuries following MIS XLIF\/XLIF. Does this mean that these procedures (e.g. XLIF\/MIS XLIF) are unsafe?<\/jats:p>\n<\/jats:sec>","DOI":"10.25259\/sni_563_2019","type":"journal-article","created":{"date-parts":[[2019,11,29]],"date-time":"2019-11-29T08:55:54Z","timestamp":1575017754000},"page":"233","update-policy":"http:\/\/dx.doi.org\/10.25259\/crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Many Intraoperative Monitoring Modalities Have Been Developed To Limit Injury During Extreme Lateral Interbody Fusion (XLIF\/MIS XLIF): Does That Mean XLIF\/MIS XLIF Are Unsafe?"],"prefix":"10.25259","volume":"10","author":[{"suffix":"M.D.","given":"Nancy E.","family":"Epstein","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"10894","published-online":{"date-parts":[[2019,11,29]]},"reference":[{"issue":"2","key":"10.25259\/SNI_563_2019\/ref-1","doi-asserted-by":"crossref","first-page":"457","DOI":"10.1007\/s10143-017-0863-7","article-title":"Femoral nerve and lumbar plexus injury after minimally invasive lateral retroperitoneal transpsoas approach: electrodiagnostic prognostic indicators and a roadmap to recovery","volume":"41","author":"Abel","year":"2018","journal-title":"Neurosurg Rev"},{"issue":"5","key":"10.25259\/SNI_563_2019\/ref-2","doi-asserted-by":"crossref","first-page":"549","DOI":"10.1007\/s10877-015-9713-8","article-title":"Trans-cranial motor evoked potential detection of femoral nerve injury in trans-psoas lateral lumbar interbody fusion","volume":"29","author":"Chaudhary","year":"2015","journal-title":"J Clin Monit Comput"},{"key":"10.25259\/SNI_563_2019\/ref-3","first-page":"S692","article-title":"Extreme lateral lumbar interbody fusion: Do the cons outweigh the pros?","volume-title":"Surg Neurol Int","volume":"7","author":"Epstein","year":"2016"},{"key":"10.25259\/SNI_563_2019\/ref-4","first-page":"S652","article-title":"High neurological complication rates for extreme lateral lumbar interbody fusion and related techniques: A review of safety concerns","volume-title":"Surg Neurol Int","volume":"7","author":"Epstein","year":"2016"},{"issue":"2","key":"10.25259\/SNI_563_2019\/ref-5","doi-asserted-by":"crossref","first-page":"247","DOI":"10.21037\/jss.2018.06.01","article-title":"Neurologic adverse event avoidance in lateral lumbar interbody fusion: technical considerations using muscle relaxants","volume":"4","author":"Fogel","year":"2018","journal-title":"J Spine Surg"},{"issue":"4","key":"10.25259\/SNI_563_2019\/ref-6","doi-asserted-by":"crossref","first-page":"456","DOI":"10.3171\/2016.1.SPINE151069","article-title":"Prevention of neurological complications using a neural monitoring system with a finger electrode in the extreme lateral interbody fusion approach","volume":"25","author":"Narita","year":"2016","journal-title":"J Neurosurg Spine"},{"issue":"10","key":"10.25259\/SNI_563_2019\/ref-7","doi-asserted-by":"crossref","first-page":"1763","DOI":"10.1016\/j.spinee.2018.02.024","article-title":"Use of motor evoked potentials during lateral lumbar interbody fusion reduces postoperative d\u00e9ficits","volume":"18","author":"Riley","year":"2018","journal-title":"Spine J"},{"key":"10.25259\/SNI_563_2019\/ref-8","doi-asserted-by":"crossref","first-page":"378","DOI":"10.1007\/s00586-015-3871-8","article-title":"Can triggered electromyography monitoring throughout retraction predict postoperative symptomatic neuropraxia after XLIF? Results from a prospective multicenter trial","volume":"24","author":"Uribe","year":"2015","journal-title":"Eur Spine J"}],"container-title":["Surgical Neurology International"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/surgicalneurologyint.com\/many-intraoperative-monitoring-modalities-have-been-developed-to-limit-injury-during-extreme-lateral-interbody-fusion-xlif-mis-xlif-does-that-mean-xlif-mis-xlif-are-unsafe\/","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/surgicalneurologyint.com\/surgicalint-articles\/many-intraoperative-monitoring-modalities-have-been-developed-to-limit-injury-during-extreme-lateral-interbody-fusion-xlif-mis-xlif-does-that-mean-xlif-mis-xlif-are-unsafe\/","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2019,11,29]],"date-time":"2019-11-29T08:55:57Z","timestamp":1575017757000},"score":1,"resource":{"primary":{"URL":"http:\/\/surgicalneurologyint.com\/surgicalint-articles\/many-intraoperative-monitoring-modalities-have-been-developed-to-limit-injury-during-extreme-lateral-interbody-fusion-xlif-mis-xlif-does-that-mean-xlif-mis-xlif-are-unsafe\/"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,11,29]]},"references-count":8,"alternative-id":["10.25259\/SNI_563_2019"],"URL":"https:\/\/doi.org\/10.25259\/sni_563_2019","relation":{},"ISSN":["2152-7806"],"issn-type":[{"value":"2152-7806","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,11,29]]},"article-number":"233"}}