Application of multimodal intraoperative neurophysiological monitoring in extreme lateral interbody fusion via the psoas muscle approach for degenerative scoliosis

doi:10.13418/j.issn.1001-165x.2026.4.18

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Chinese Journal of Clinical Anatomy ›› 2026, Vol. 44 ›› Issue (4) : 486-490. DOI: 10.13418/j.issn.1001-165x.2026.4.18

Application of multimodal intraoperative neurophysiological monitoring in extreme lateral interbody fusion via the psoas muscle approach for degenerative scoliosis

Hu Wei, Zhang Qingshun, Wang Le, Liu Song, Liang Daxuan, Wu Zenghui*

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Abstract

Objective To investigate the application of multimodal intraoperative neuromonitoring (IONM) in transpsoas extreme lateral interbody fusion (XLIF) for degenerative scoliosis. Methods A retrospective analysis was conducted on clinical data from 19 patients with degenerative scoliosis who underwent XLIF surgery with multimodal IONM at the Third Affiliated Hospital of Guangzhou Medical University, between January 2021 and December 2023. Results All patients were successfully completed the surgery, with an average operative time of (262 ± 94) min. Postoperative coronal Cobb angle of the major curve was (8 ± 6) °, achieving a correction rate of (73 ± 13) %. Multimodal monitoring triggered alerts in 3 cases: Postoperative muscle weakness happened in 2 patients, who gradually resolved after treatment, while 1 patient showed no neurological deficits. The sensitivity of multimodal IONM was 100%, and specificity was 94.1%. Conclusions Multimodal IONM compensates for the limitations of single-mode monitoring, improves diagnostic accuracy, reduces the risk of neurological injury in XLIF procedures, and facilitates the technical promotion and expanded application of XLIF.

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Multimodal intraoperative neurophysiological monitoring / / / Lateral lumbar interbody fusion / Degenerative scoliosis

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Hu Wei, Zhang Qingshun, Wang Le, Liu Song, Liang Daxuan, Wu Zenghui. Application of multimodal intraoperative neurophysiological monitoring in extreme lateral interbody fusion via the psoas muscle approach for degenerative scoliosis[J]. Chinese Journal of Clinical Anatomy. 2026, 44(4): 486-490 https://doi.org/10.13418/j.issn.1001-165x.2026.4.18

References

[1] Paterakis KN, Brotis AG, Paschalis A, et al. Extreme lateral lumbar interbody fusion (XLIF) in the management of degenerative scoliois: a retrospective case series [J]. J Spine Surg, 2018, 4(3): 610-615. DOI: 10.21037/jss.2018.07.11.
[2] Phillips FM, Isaacs RE, Rodgers WB, et al. Adult degenerative scoliosis treated with XLIF: clinical and radiographical results of a prospective multicenter study with 24-month follow-up [J]. Spine, 2013, 38(21): 1853-1861. DOI: 10.1097/BRS.0b013e3182a43f0b.
[3] Alonso F, Graham R, Rustagi T, et al. Subcostal nerve during lateral approaches to the lumbar spine: an anatomical study with relevance for injury avoidance and postoperative complications such as abdominal wall hernia [J]. World Neurosurg, 2017, 104: 669-673. DOI: 10.1016/j.wneu.2017.05.055.
[4] Grunert P, Drazin D, Iwanaga J, et al. Injury to the lumbar plexus and its branches after lateral fusion procedures: a cadaver study [J]. World Neurosurg, 2017, 105: 519-525. DOI: 10.1016/j.wneu.2017.06.027.
[5] Uribe JS, Arredondo N, Dakwar E, et al. Defining the safe working zones using the minimally invasive lateral retroperitoneal transpsoas approach: an anatomical study [J]. J Neurosurg Spine, 2010, 13(2): 260-266. DOI: 10.3171/2010.3.SPINE09766.
[6] 中国医师协会神经外科医师分会神经电生理学组. 脊髓脊柱手术中神经电生理监测专家共识(2022版)[J]. 中华神经外科杂志, 2022, 38(4):7. DOI: 10.3760/cma.j.cn112050-20211213-00583.
Chinese Neurosurgical Society, Neuroelectrophysiology Group. Expert consensus on neuroelectrophysiological monitoring during spinal and spinal cord surgeries (2022 edition) [J]. Chin J Neurosurg, 2022, 38(4): 7. DOI:10.3760/cma.j.cn112050-20211213-00583.
[7] Epstein NE. Review of risks and complications of extreme lateral interbody fusion (XLIF) [J]. Surg Neurol Int, 2019, 10: 237. DOI: 10.25259/SNI_559_2019.
[8] Malhotra NR, Shaffrey CI. Intraoperative electrophysiological monitoring in spine surgery [J]. Spine, 2010, 35(25): 2167-2179. DOI: 10.1097/BRS.0b013e3181f6f0d0.
[9] Lall RR, Lall RR, Hauptman JS, et al. Intraoperative neurophysiological monitoring in spine surgery: indications, efficacy, and role of the preoperative checklist [J]. Neurosurg Focus, 2012, 33(5): E10. DOI: 10.3171/2012.9.FOCUS12235.
[10]Costa P, Bruno A, Bonzanino M, et al. Somatosensory- and motor-evoked potential monitoring during spine and spinal cord surgery [J]. Spinal Cord, 2007, 45(1): 86-91. DOI: 10.1038/sj.sc.3101934.
[11] Sloan TB, Janik D, Jameson L. Multimodality monitoring of the central nervous system using motor-evoked potentials [J]. Curr Opin Anaesthesiol, 2008, 21(5): 560-564. DOI: 10.1097/ACO.0b013e32830f1fbd.
[12] 李天扬, 邱俊荫, 丰成, 等. 体感诱发电位联合运动诱发电位在严重脊柱侧后凸畸形患者矫形手术中的应用价值[J]. 中国脊柱脊髓杂志, 2018, 28(9): 5. DOI: 10.3969/j.issn.1004-406X.2018.09.01.
Li TY, Qiu JY, Feng C, et al. Somatosensory evoked potentials combined with transcranial electric motor evoked potentials in posteriorspinal correction and fusion for severe kyphoscoliosis[J]. Chin J Spine Spinal Cord, 2018, 28(9): 769-773. DOI: 10.3969/j.issn.1004-406X.2018.09.01.
[13]Weinzierl MR, Reinacher P, Gilsbach JM, et al. Combined motor and somatosensory evoked potentials for intraoperative monitoring: intra- and postoperative data in a series of 69 operations[J]. Neurosurg Rev, 2007, 30(2):109-116. DOI: 10.1007/s10143-006-0061-5.
[14] 邱俊荫, 史本龙, 刘臻, 等. 术中神经电生理监测在不同病因学的脊柱畸形矫治手术中的应用价值[J]. 中华骨科杂志, 2016, 36(24): 6. DOI: 10.3760/cma.j.issn.0253-2352.2016.24.010.
Qiu JY, Shi BL, Liu Z, et al. Application of intraoperative neurophysiological monitoring in surgical correction for spinal deformity with different etiologies[J]. Chin J Orthop, 2016, 36(24): 6. DOI: 10.3760/cma.j.issn.0253-2352.2016.24.010.
[15]Wang S, Zhang J, Tian Y, et al. Intraoperative motor evoked potential monitoring to patients with preoperative spinal deficits: judging its feasibility and analyzing the significance of rapid signal loss[J]. Spine Journal, 2015:777. DOI: 10.1016/j.spinee.2015.09.028.
[16]刘臻, 邱勇, 朱卫国, 等．伴神经损害脊柱侧后凸畸形患者脊髓内移后路矫形术后神经电生理变化[J]. 中国脊柱脊髓杂志，2015, 25(1): 580-584. DOI: 10.39690.issn.1004-406X.
Liu Z, Qiu Y, Zhu WG, et al, Neurological outcomes of transvertebral transposition of the spinal cord and posterior correction in patients suffering from neurologic deficit secondary to angular kyphoscoliosis[J]. Chin J Spine Spinal Cord, 2015, 25(7): 580-584. DOI: 10.39690.issn.1004-406X.
[17] 冯宾, 沈建雄, 仉建国, 等. 经颅刺激运动诱发电位联合体感诱发电位监测在特发性脊柱侧凸矫形手术中应用的研究 [J]. 中国骨与关节外科, 2013(2): 167-172. DOI: 10.3969/j.issn.1674-1439.2013.04-016.
Feng B, Shen JX, Zhang JG, et al. Impact of combined transcranial electric stimulation motor evoked and somatosensoryevoked potential monitoring during surgery for idiopathic scoliosis[J]. Chin J Bone Joint Surger, 2013(2): 167-172. DOI: 10.3969/j.issn.1674-1439.2013.04-016.
[18] 王雨晨, 齐华光, 杨姝怡, 等. 多模式术中监测在脊柱侧弯手术患者脊髓及神经根功能评估中的应用价值[J]. 医学临床研究, 2023, 40(5): 768-770. DOI: 10.3969/j.issn.1671-7171.2023.05.037.
Wang YC, Qi HG, Yang SY, et al. The Application Value of Multimodal Intraoperative Monitoring in the Evaluation of Spinal Cord and Nerve Root Function in Patients Undergoing Scoliosis Surgery [J]. J Clin Res, 2023, 40(5): 768-770. DOI: 10.3969/j.issn.1671-7171.2023.05.037.
[19]Benglis DM, Samy EM, Levi AD, et al. Minimally invasive anterolateral appro-aches for the treatment of back pain and adult degenerative deformity[J]. Neurosurgery, 2008(suppl_3): 191. DOI: 10.1227/01.NEU.0000325487.49020.91.
[20]田永刚, 江汉, 江毅, 等. 小切口XLIF与后正中入路PLIF椎弓根螺钉固定治疗退变性腰椎侧凸 [J] . 中华骨科杂志, 2015, 35(9): 8. DOI: 10.3760/cma.j.issn.0253-2352.2015.09.003.
Tian YG, Jiang H, Jiang Y, et al, Clinical outcomes of XLIF through small incision approach versus PILF with open surgery for degenerative lumbar scoliosis[J]. Chin J Orthop, 2015, 35(9): 8. DOI: 10.3760/cma.j.issn.0253-2352.2015.09.003.
[22]孙彦鹏, 彭晓东, 裴冬阳, 等. XLIF与MIS-TLIF手术治疗腰椎退行性疾病的疗效分析 [J]. 颈腰痛杂志, 2022, 43(6): 822-826. DOI: 10.3969/j.issn.1005-7234.2022.06.011.
Sun YP, Peng XD, Pei DY, et al. Efficacy analysis of XLIF and MIS-TLIF in the treatment of lumbar degenerative diseases [J]. J Cervicodynia Lumbodynia, 2022, 43(6): 822-826. DOI: 10.3969/j.issn.1005-7234.2022.06.011.
[23]张玉龙, 角述兰. 运动诱发电位与麻醉的研究进展 [J]. 临床麻醉学杂志, 2013, 29(7): 718-720.
Zhang YL, Jiao SL. Research progress on motor evoked potentials and anesthesia[J]. J Clin Anesthesiol, 2013, 29(7): 718-720.
[24]王凌雁, 窦云凌, 张恒, 等. 部分神经肌肉阻滞及不同麻醉深度对经颅电刺激运动诱发电位的影响 [J]. 中华神经外科杂志, 2011, 27(8): 4. DOI: 10.3760/cma.j.issn.1001-2346.2011.08.026.
Wang LY, Dou YL, Zhang H, et al. Influences of partial muscle relax and depth of anesthesia on transcranial electrical motor evoked potential[J]. Chin J Neurosurg, 2011, 27(8): 4. DOI: 10.3760/cma.j.issn.1001-2346.2011.08.026.
[25]Tamkus A A, Rice K S, Kim H L. Differential rates of false-positive findings in transcranial electric motor evoked potential monitoring when using inhalational anesthesia versus total intravenous anesthesia during spine surgeries [J]. Spine J, 2014, 14(8): 1440-1446. DOI: 10.1016/j.spinee.2013.08.037.
[26]Wanyou Liu, Yinkun Li, Junyin Qiu, et al. Intra-operative neurophysiological monitoring in patients undergoing posterior spinal correction surgery with pre-operative neurological deficit: Its feasibility and high-risk factors for failed monitoring[J]. Orthop surg, 2023, 15(12): 7. DOI: 10.1111/os.13914.
[27]Sala F, Palandri G, Basso E, et al. Motor evoked potential monitoring improves outcome after surgery for intramedullary spinal cord tumors: a historical control study[J]. Neurosurg, 2006, 58(6): 1129-1143. DOI: 10.1227/01.NEU.0000215948.97195.58.