{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T00:56:50Z","timestamp":1782867410904,"version":"3.54.5"},"reference-count":28,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"26","license":[{"start":{"date-parts":[[2026,6,29]],"date-time":"2026-06-29T00:00:00Z","timestamp":1782691200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Neurosurg Case Lessons"],"published-print":{"date-parts":[[2026,6,29]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND<\/jats:title>\n                    <jats:p>Lateral lumbar interbody fusion (LLIF) is a minimally invasive spinal fusion technique utilizing a lateral transpsoas approach to access the anterior column of the spine. Vascular injury is a rare complication but difficult to manage due to the minimally invasive nature of the procedure, making it critical to carefully review preoperative imaging prior to committing to a lateral approach.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>OBSERVATIONS<\/jats:title>\n                    <jats:p>A 67-year-old female presented with progressive low back pain and left lower extremity pain and sensory changes. MRI showed a grade 1 L4\u20135 spondylolisthesis with left-sided neuroforaminal stenosis. The patient was recommended for LLIF; however, on further review of the MRI findings, an abnormally dilated left gonadal vein (GV) was identified along the psoas muscle. Subsequent imaging revealed compression of the left renal vein between the superior mesenteric artery and aorta, causing venous outflow obstruction. Therefore, the surgical approach was changed to avoid potential vascular complications.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>LESSONS<\/jats:title>\n                    <jats:p>GV injury is a rare but major complication of lateral spine surgery. This case highlights the importance of careful preoperative imaging and anatomical review as lateral approaches become more common, and acts as a cautionary report for vascular review prior to LLIF.<\/jats:p>\n                    <jats:p>\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/thejns.org\/doi\/10.3171\/CASE26180\">https:\/\/thejns.org\/doi\/10.3171\/CASE26180<\/jats:ext-link>\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/case26180","type":"journal-article","created":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T00:19:48Z","timestamp":1782865188000},"source":"Crossref","is-referenced-by-count":0,"title":["Nutcracker phenomenon resulting in left gonadal vein dilation as a critical vascular consideration prior to lateral lumbar interbody fusion: illustrative case"],"prefix":"10.3171","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7900-5151","authenticated-orcid":true,"given":"Liam P.","family":"Hughes","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph M.","family":"White","sequence":"additional","affiliation":[{"name":"Department of Surgery, Division of Vascular Surgery and Endovascular Therapy, Johns Hopkins University School of Medicine, Baltimore, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-3523-4808","authenticated-orcid":true,"given":"Louis","family":"Chang","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"1","key":"bib1","series-title":"J Spine Surg","first-page":"2","article-title":"Lumbar interbody fusion: techniques, indications and comparison of interbody fusion options including PLIF, TLIF, MI-TLIF, OLIF\/ATP, LLIF and ALIF","volume":"1","author":"Mobbs","year":"2015","unstructured":"Mobbs RJPhan KMalham GSeex KRao PJ.Lumbar interbody fusion: techniques, indications and comparison of interbody fusion options including PLIF, TLIF, MI-TLIF, OLIF\/ATP, LLIF and ALIF. J Spine Surg. 2015;1(1):2-18. doi:10.3978\/j.issn.2414-469X.2015.10.05"},{"issue":"2","key":"bib2","series-title":"J Am Acad Orthop Surg","first-page":"96","article-title":"Lateral lumbar interbody fusion: indications, outcomes, and complications","volume":"24","author":"Kwon","year":"2016","unstructured":"Kwon BKim DH.Lateral lumbar interbody fusion: indications, outcomes, and complications. J Am Acad Orthop Surg. 2016;24(2):96-105. doi:10.5435\/JAAOS-D-14-00208"},{"issue":"4","key":"bib3","series-title":"Spine J","first-page":"435","article-title":"Extreme lateral interbody fusion (XLIF): a novel surgical technique for anterior lumbar interbody fusion","volume":"6","author":"Ozgur","year":"2006","unstructured":"Ozgur BMAryan HEPimenta LTaylor WR.Extreme lateral interbody fusion (XLIF): a novel surgical technique for anterior lumbar interbody fusion. Spine J. 2006;6(4):435-443. doi:10.1016\/j.spinee.2005.08.012"},{"issue":"11","key":"bib4","series-title":"J Clin Neurosci","first-page":"1714","article-title":"Lateral lumbar interbody fusion for sagittal balance correction and spinal deformity","volume":"22","author":"Phan","year":"2015","unstructured":"Phan KRao PJScherman DBDandie GMobbs RJ.Lateral lumbar interbody fusion for sagittal balance correction and spinal deformity. J Clin Neurosci. 2015;22(11):1714-1721. doi:10.1016\/j.jocn.2015.03.050"},{"issue":"9","key":"bib5","series-title":"Eur Spine J","first-page":"4213","article-title":"Investigating complications of extreme lateral interbody fusion (XLIF) in the food and drug administration manufacturer and user facility device experience database","volume":"34","author":"Madhu","year":"2025","unstructured":"Madhu PHughes LPAzad TDInvestigating complications of extreme lateral interbody fusion (XLIF) in the food and drug administration manufacturer and user facility device experience database. Eur Spine J. 2025;34(9):4213-4221. doi:10.1007\/s00586-025-09174-4"},{"issue":"1","key":"bib6","series-title":"J Neurosurg Spine","first-page":"11","article-title":"An analysis of postoperative thigh symptoms after minimally invasive transpsoas lumbar interbody fusion","volume":"15","author":"Cummock","year":"2011","unstructured":"Cummock MDVanni SLevi ADYu YWang MY.An analysis of postoperative thigh symptoms after minimally invasive transpsoas lumbar interbody fusion. J Neurosurg Spine. 2011;15(1):11-18. doi:10.3171\/2011.2.SPINE10374."},{"issue":"1","key":"bib7","series-title":"Evid Based Spine-Care J","first-page":"28","article-title":"Lumbar lateral interbody fusion (LLIF): comparative effectiveness and safety versus PLIF\/TLIF and predictive factors affecting LLIF outcome","volume":"5","author":"Barbagallo","year":"2014","unstructured":"Barbagallo GMVAlbanese VRaich ALDettori JRSherry NBalsano M.Lumbar lateral interbody fusion (LLIF): comparative effectiveness and safety versus PLIF\/TLIF and predictive factors affecting LLIF outcome. 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Anat Sci Int. 2023;98(1):143-146. doi:10.1007\/s12565-022-00684-5"},{"issue":"2","key":"bib10","series-title":"J Clin Diagn Res","first-page":"AC08","article-title":"Variations of gonadal veins: embryological prospective and clinical significance","volume":"9","author":"Gupta","year":"2015","unstructured":"Gupta RGupta AAggarwal N.Variations of gonadal veins: embryological prospective and clinical significance. J Clin Diagn Res. 2015;9(2):AC08-AC10. doi:10.7860\/JCDR\/2015\/9493.5578"},{"issue":"2","key":"bib11","series-title":"J Vasc Surg Venous Lymphat Disord","first-page":"271","article-title":"A systematic review on management of nutcracker syndrome","volume":"6","author":"Velasquez","year":"2018","unstructured":"Velasquez CASaeyeldin AZafar MABrownstein AJErben Y.A systematic review on management of nutcracker syndrome. 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Orthop Surg. 2018;10(2):98-106. doi:10.1111\/os.12380"},{"issue":"2","key":"bib14","series-title":"Neurosurg Rev","first-page":"1275","article-title":"Incidence of major and minor vascular injuries during lateral access lumbar interbody fusion procedures: a retrospective comparative study and systematic literature review","volume":"45","author":"Aguirre","year":"2022","unstructured":"Aguirre AOSoliman MARAzmy SIncidence of major and minor vascular injuries during lateral access lumbar interbody fusion procedures: a retrospective comparative study and systematic literature review. 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J Am Acad Orthop Surg. 2016;24(2):96-105. doi:10.5435\/JAAOS-D-14-00208"},{"issue":"4","key":"bib3","series-title":"Spine J","first-page":"435","article-title":"Extreme lateral interbody fusion (XLIF): a novel surgical technique for anterior lumbar interbody fusion","volume":"6","author":"Ozgur","year":"2006","unstructured":"Ozgur BMAryan HEPimenta LTaylor WR.Extreme lateral interbody fusion (XLIF): a novel surgical technique for anterior lumbar interbody fusion. Spine J. 2006;6(4):435-443. doi:10.1016\/j.spinee.2005.08.012"},{"issue":"11","key":"bib4","series-title":"J Clin Neurosci","first-page":"1714","article-title":"Lateral lumbar interbody fusion for sagittal balance correction and spinal deformity","volume":"22","author":"Phan","year":"2015","unstructured":"Phan KRao PJScherman DBDandie GMobbs RJ.Lateral lumbar interbody fusion for sagittal balance correction and spinal deformity. 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