{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T21:15:04Z","timestamp":1790025304845,"version":"4.0.1"},"reference-count":27,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["SPI"],"published-print":{"date-parts":[[2011,1]]},"abstract":"<jats:sec>\n<jats:title>Object<\/jats:title>\n<jats:p>Because the psoas muscle, which contains nerves of the lumbar plexus, is traversed during the extreme lateral interbody fusion (XLIF) approach, appropriate nerve monitoring is needed to avoid nerve injury during surgery and prevent approach-related neural deficit. This study was performed to assess the effectiveness of dynamically evoked electromyography (EMG) to detect and prevent neural injury during the XLIF approach.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>Methods<\/jats:title>\n<jats:p>One hundred two patients undergoing XLIF at L3\u20134 and\/or L4\u20135 were enrolled in a prospective, multicenter, nonrandomized clinical study. The EMG threshold values for each of the 3 successive dilators were recorded at the surface of the psoas muscle, mid-psoas, and on the spine. At each location, the dilators were rotated 360\u00b0, taking recordings immediately posterior, superior, anterior, and inferior. For each dilator, the authors noted the rotational position (the angle in degrees) at which the lowest threshold was found. Findings of pre- and postoperative neurological examinations were also recorded.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>Results<\/jats:title>\n<jats:p>Nerves were identified within proximity of the dilators (alert-level EMG feedback) in 55.7% of all cases during the XLIF approach. Although nerves were more commonly identified in the posterior margin (63%), there was significant variability in the location of nerves identified. Despite the fact that the posterior half of the disc space was targeted in 90% of cases, no significant long-lasting neural deficits were identified in any case; 27.5% experienced new iliopsoas\/hip flexion weakness and 17.6% experienced new postoperative upper medial thigh sensory loss. Transient motor deficits were identified in 3 patients (2.9%), and all had resolved by the 6-month follow-up visit.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>Conclusions<\/jats:title>\n<jats:p>The ability to identify and report a discrete, real-time EMG threshold during the transpsoas approach helps to avoid nerve injury and is required for the safe performance of the XLIF procedure. Additionally, nerve location is variable, thus reinforcing the need for real-time directional and proximity information.<\/jats:p><\/jats:sec>","DOI":"10.3171\/2010.9.spine09871","type":"journal-article","created":{"date-parts":[[2010,12,17]],"date-time":"2010-12-17T15:02:36Z","timestamp":1292598156000},"page":"31-37","source":"Crossref","is-referenced-by-count":180,"title":["Dynamically evoked, discrete-threshold electromyography in the extreme lateral interbody fusion approach"],"prefix":"10.3171","volume":"14","author":[{"given":"Antoine G.","family":"Tohmeh","sequence":"first","affiliation":[{"name":"Northwest Orthopaedic Specialists, Spokane, Washington;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William Blake","family":"Rodgers","sequence":"additional","affiliation":[{"name":"Spine Midwest, Jefferson City, Missouri; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark D.","family":"Peterson","sequence":"additional","affiliation":[{"name":"Southern Oregon Orthopedics, Medford, Oregon"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1-spine09871","series-title":"J Spinal Disord Tech","doi-asserted-by":"publisher","first-page":"459","DOI":"10.1097\/BSD.0b013e318167b06b","article-title":"Minimally invasive multilevel percutaneous correction and fusion for adult lumbar degenerative scoliosis: a technique and feasibility study","volume":"21","author":"Anand","year":"2008"},{"key":"b2-spine09871","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"1191","DOI":"10.1097\/00006123-200211000-00014","article-title":"Allograft implants for posterior lumbar interbody fusion: results comparing cylindrical dowels and impacted wedges","volume":"51","author":"Barnes","year":"2002"},{"key":"b3-spine09871","series-title":"J Neurosurg Spine","doi-asserted-by":"publisher","first-page":"139","DOI":"10.3171\/2008.10.SPI08479","article-title":"An anatomical study of the lumbosacral plexus as related to the minimally invasive transpsoas approach to the lumbar spine. Laboratory investigation","volume":"10","author":"Benglis","year":"2009"},{"key":"b4-spine09871","series-title":"Spine","doi-asserted-by":"publisher","first-page":"1681","DOI":"10.1097\/01.BRS.0000133643.75795.EF","article-title":"Endoscopic lateral transpsoas approach to the lumbar spine","volume":"29","author":"Bergey","year":"2004"},{"key":"b5-spine09871","series-title":"Spine","doi-asserted-by":"publisher","first-page":"2780","DOI":"10.1097\/00007632-199412150-00008","article-title":"Stimulus-evoked EMG monitoring during transpedicular lumbosacral spine instrumentation. Initial clinical results","volume":"19","author":"Calancie","year":"1994"},{"key":"b6-spine09871","series-title":"J Bone Joint Surg Am","first-page":"2089","article-title":"Perioperative complications of posterior lumbar decompression and arthrodesis in older adults","volume":"85-A","author":"Carreon","year":"2003"},{"key":"b7-spine09871","series-title":"Spine","doi-asserted-by":"publisher","first-page":"2232","DOI":"10.1097\/BRS.0b013e31814b2d3c","article-title":"Complications in posterior fusion and instrumentation for degenerative lumbar scoliosis","volume":"32","author":"Cho","year":"2007"},{"key":"b8-spine09871","series-title":"Spine","doi-asserted-by":"publisher","first-page":"1963","DOI":"10.1097\/BRS.0b013e3181ae2243","article-title":"National complication rates and disposition after posterior lumbar fusion for acquired spondylolisthesis","volume":"34","author":"Kalanithi","year":"2009"},{"key":"b9-spine09871","series-title":"Spine","doi-asserted-by":"publisher","first-page":"1351","DOI":"10.1097\/01.brs.0000218635.14571.55","article-title":"Clinical outcomes of 3 fusion methods through the posterior approach in the lumbar spine","volume":"31","author":"Kim","year":"2006"},{"key":"b10-spine09871","series-title":"J Spinal Disord","doi-asserted-by":"publisher","first-page":"301","DOI":"10.1097\/00002517-200108000-00004","article-title":"Lumbar posterolateral fusion alone or with transpedicular instrumentation in L4\u2013L5 degenerative spondylolisthesis","volume":"14","author":"Kimura","year":"2001"},{"key":"b11-spine09871","series-title":"J Spinal Disord Tech","doi-asserted-by":"publisher","first-page":"34","DOI":"10.1097\/BSD.0b013e3181679b8a","article-title":"Direct lateral lumbar interbody fusion for degenerative conditions: early complication profile","volume":"22","author":"Knight","year":"2009"},{"key":"b12-spine09871","series-title":"Spine J","doi-asserted-by":"publisher","first-page":"374","DOI":"10.1016\/j.spinee.2006.09.004","article-title":"Incidence, etiology, classification, and management of neuralgia after posterior lumbar interbody fusion surgery in 226 patients","volume":"8","author":"Krishna","year":"2008"},{"key":"b13-spine09871","series-title":"Spine","doi-asserted-by":"publisher","first-page":"1068","DOI":"10.1097\/00007632-199505000-00015","article-title":"Evaluation of intrapedicular screw position using intraoperative evoked electromyography","volume":"20","author":"Maguire","year":"1995"},{"key":"b14-spine09871","series-title":"Spine","doi-asserted-by":"publisher","first-page":"1476","DOI":"10.1097\/00007632-199807010-00009","article-title":"Minimally invasive anterior retroperitoneal approach to the lumbar spine. Emphasis on the lateral BAK","volume":"23","author":"McAfee","year":"1998"},{"key":"b15-spine09871","series-title":"Spine","doi-asserted-by":"publisher","first-page":"423","DOI":"10.1097\/01.BRS.0000049226.87064.3B","article-title":"An anatomic study of the lumbar plexus with respect to retroperitoneal endoscopic surgery","volume":"28","author":"Moro","year":"2003"},{"key":"b16-spine09871","series-title":"J Neurosurg Spine","doi-asserted-by":"publisher","first-page":"304","DOI":"10.3171\/spi.2006.4.4.304","article-title":"Surgical complications of posterior lumbar interbody fusion with total facetectomy in 251 patients","volume":"4","author":"Okuda","year":"2006"},{"key":"b17-spine09871","series-title":"Spine J","doi-asserted-by":"publisher","first-page":"435","DOI":"10.1016\/j.spinee.2005.08.012","article-title":"Extreme Lateral Interbody Fusion (XLIF): a novel surgical technique for anterior lumbar interbody fusion","volume":"6","author":"Ozgur","year":"2006"},{"key":"b18-spine09871","series-title":"J Spinal Disord Tech","doi-asserted-by":"publisher","first-page":"223","DOI":"10.1097\/BSD.0b013e3181a9d540","article-title":"The relationship of intrapsoas nerves during a transpsoas approach to the lumbar spine: anatomic study","volume":"23","author":"Park","year":"2010"},{"key":"b19-spine09871","series-title":"eXtreme Lateral Interbody Fusion (XLIF)","first-page":"87","article-title":"Surgical technique: eXtreme lateral interbody fusion","author":"Pimenta","year":"2008"},{"key":"b20-spine09871","series-title":"J Spinal Disord Tech","doi-asserted-by":"publisher","first-page":"161","DOI":"10.1097\/01.bsd.0000188663.46391.73","article-title":"Complications associated with minimally invasive decompression for lumbar spinal stenosis","volume":"19","author":"Podichetty","year":"2006"},{"key":"b21-spine09871","series-title":"Spine","doi-asserted-by":"publisher","first-page":"2171","DOI":"10.1097\/00007632-199910150-00018","article-title":"Laparoscopic approach to L4\u2013L5 for interbody fusion using BAK cages: experience in the first 58 cases","volume":"24","author":"Regan","year":"1999"},{"key":"b22-spine09871","series-title":"eXtreme Lateral Interbody Fusion (XLIF)","first-page":"105","article-title":"Safety of XLIF afforded by automated neurophysiology monitoring with NeuroVision","author":"Rodgers","year":"2008"},{"key":"b23-spine09871","series-title":"J Spinal Disord Tech","doi-asserted-by":"publisher","first-page":"393","DOI":"10.1097\/BSD.0b013e3181b31729","article-title":"Early complications of extreme lateral interbody fusion in the obese","volume":"23","author":"Rodgers","year":"2010"},{"key":"b24-spine09871","series-title":"US Musculoskeletal Review","first-page":"28","article-title":"Experience and early results with a minimally invasive technique for anterior column support through eXtreme Lateral Interbody Fusion (XLIF)","volume":"1","author":"Rodgers","year":"2007"},{"key":"b25-spine09871","series-title":"Spine","article-title":"Intraoperative and early postoperative complications in extreme lateral interbody fusion (XLIF): an analysis of 600 cases","author":"Rodgers","year":"2010"},{"key":"b26-spine09871","series-title":"Spine","doi-asserted-by":"publisher","first-page":"670","DOI":"10.1097\/01.brs.0000155423.18218.75","article-title":"Analysis of operative complications in a series of 471 anterior lumbar interbody fusion procedures","volume":"30","author":"Sasso","year":"2005"},{"key":"b27-spine09871","series-title":"J Spinal Disord Tech","doi-asserted-by":"publisher","first-page":"92","DOI":"10.1097\/01.bsd.0000185277.14484.4e","article-title":"Perioperative complications in transforaminal lumbar interbody fusion versus anterior-posterior reconstruction for lumbar disc degeneration and instability","volume":"19","author":"Villavicencio","year":"2006"}],"container-title":["Journal of Neurosurgery: Spine"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-spine\/14\/1\/article-p31.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-spine\/14\/1\/article-p31.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-spine\/14\/1\/article-p31.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,4,15]],"date-time":"2023-04-15T22:12:23Z","timestamp":1681596743000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-spine\/14\/1\/article-p31.xml"}},"subtitle":["Clinical article"],"short-title":[],"issued":{"date-parts":[[2011,1]]},"references-count":27,"journal-issue":{"issue":"1"},"URL":"https:\/\/doi.org\/10.3171\/2010.9.spine09871","relation":{},"ISSN":["1547-5654"],"issn-type":[{"value":"1547-5654","type":"print"}],"subject":[],"published":{"date-parts":[[2011,1]]}}}