XLIF

Background

  • also known as LLIF / PLIF

Complications

  • all branches of lumbar plexus in psoas muscle are at risk, particularly at L2–L4 levels, during exposure, dilation, and retraction.

Iliophypogastric / ilioinguinal Nerve Injury

  • The retroperitoneal approach passes through the lateral abdominal wall muscles (external oblique → internal oblique → transversus abdominis).
  • The iliohypogastric and ilioinguinal nerves run between these muscle layers.
  • Retraction, splitting, or cautery in this area can injure or denervate these nerves, which control internal oblique and transversus abdominis.
  • The external oblique and other intact muscles continue to contract normally, creating uneven tension. → lateral abdominal wall weakness and visible protrusion — a pseudohernia, not a true hernia.
 
notion image

Femoral Nerve Injury

🚨 Why Quadriceps Weakness Is Concerning (femoral nerve injury)
  • Most common feared complications: femoral nerve injury (runs within or anterior to psoas)
    • Loss of knee extension
    • Weakness in hip flexion (iliopsoas involvement)
    • Reduced or absent patellar reflex
 
🩻 Other (less critical but possible) weaknesses
Weakness
Likely cause
Comment
Hip adduction
Obturator nerve injury
Through medial psoas
Foot dorsiflexion / eversion
Peroneal branch of sciatic nerve
Rare, from traction or positioning
Hip flexion only (without quad weakness)
Genitofemoral or psoas trauma
Usually transient