Vulnerability of the femoral nerve during complex anterior and posterior spinal surgery.

BACKGROUND: Femoral nerve palsy is not a common adverse effect of lumbar spinal surgery.

OBJECTIVE: To report 3 unique cases of femoral nerve neuropathy due to instrumentation and positioning during complex anterior and posterior spinal surgery.

METHODS: Case series

RESULTS: All 3 patients demonstrated femoral nerve neuropathy. The first patient presented postoperatively but after 6 months, the palsy resolved. Femoral nerve malfunctioning was documented in the second and third patients intraoperatively; however, with rapid patient repositioning and removal of offending instrumentation, postoperative palsy was avoided.

CONCLUSIONS: Use of motor evoked potential monitoring of the femoral nerve during surgery is vital for the prevention of future neuropathies, an avoidable complication of spinal surgery.