LAUSR

The Lateral Lumbar Interbody Discectomy & Fusion (LLIF) surgical procedure has grown in popularity due the many advantages this approach offers over more traditional surgical approaches. Potential complications include injury to the lumbar plexus, bowel, and vasculature with injuries to the lumbar plexus being the most common. Multiple investigators have reported promising results from various techniques aimed at monitoring the function of the lumbar plexus elements with attention on the femoral nerve. Nonetheless, there are still no well-established guidelines for performing or interpreting femoral nerve neuromonitoring for LLIFs. The authors investigate the advantages and limitations of various emerging femoral nerve neuromonitoring techniques and review key considerations for interpreting the acquired neuromonitoring data. Recommendations for femoral nerve monitoring alert criteria are proposed. There are multiple factors that can affect the quality of the acquired data and thus the utility of the neuromonitoring can vary considerably from case to case. The authors recommend a standardized format of reporting utilizing a grading scale to describe the quality of the neuromonitoring data to equip surgeons with the relevant information required for effective intraoperative decision making.