![]() CT scans and MRIs evaluated the reasons for weaknesses before surgery, and after surgery, muscle strength was registered. Patients who needed secondary surgery because of lower extremity weaknesses were selected. We counted the patients at our center that underwent posterior lumbar fusion surgery between January 2009 and December 2018. This study investigated the causes of lower extremity weaknesses after posterior lumbar spine fusion surgery and the therapeutic effects of secondary surgery when treating this complication. Secondary surgery or a prompt, surgical exploration is usually mandatory before permanent neurologic damage develops. Lower extremity motor weaknesses are some of the most severe iatrogenic neurologic complications after spinal surgery. Less commonly, distraction injuries to the spinal cord can occur from an overcorrection to the sagittal balance, or column shortening/lengthening maneuvers. Direct compressions can also occur when deformity corrective measures result in neural element compressions. They may occur via an expanding, space-occupying process such as a nerve root edema, an epidural hematoma, or via compressor instrumentation. The most common way is due to the mechanical compression of nerve roots, the spinal cord, or the dural sac. ![]() Iatrogenic neurologic deficits may occur via a number of routes. Severe complications may cause permanent damage to the neurologic system, so it is important that neurologic complications are recognized and managed. Several studies have reported that the prevalence of deficits ranges from 0.8 to 6.1%. They can manifest as radiculopathies, lower extremity weaknesses, spinal cord compressions, or postoperative neuropathic pains. Iatrogenic neurologic deficits after surgery are rare, but the most feared complications of spinal surgery. Posterior lumbar fusions-including posterolateral fusions, posterior lumbar interbody fusions, and transforaminal lumbar fusions-have become the main surgical treatment options for various spinal disorders, such as spondylolisthesis, scoliosis, stenosis, instability, trauma, or tumors. ![]() There may be positive, therapeutic effects to subsequent, active surgical exploration. The main causes of weakness were internal fixation malposition and loosening, epidural hematomas, insufficient decompression, or root edemas. Iatrogenic neurologic deficits and lower extremity weaknesses were rare complications after posterior lumbar spine fusion surgeries, but important to recognize and manage. Twenty-seven patients (90%) got improved muscle strength after their secondary surgery. Weakness occurred on average 2.9 days after surgery (1–9 days). The main causes of weakness were (1) internal fixation malposition and loosening (11 patients, 36%), (2) epidural hematomas (9 patients, 30%), (3) insufficient decompression (5 patients, 17%), and (4) nerve root edemas (5 patients, 17%). Thirty patients (30/4078, 0.74%) required a secondary surgery because of lower extremity weaknesses after posterior lumbar spine fusion surgery. Muscle strength was evaluated after surgery. CT scans and MRIs were used to evaluate the reasons for weaknesses before secondary surgery. Those who needed secondary surgery because of subsequent lower extremity weaknesses were selected. Patients who underwent posterior lumbar spine fusion surgery in the Peking University First Hospital between January 2009 and December 2018 were counted. This study was aimed at investigating the causes of lower extremity weaknesses after posterior lumbar spine fusion surgery and looking at subsequent treatment strategies.
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