Nutcracker phenomenon resulting in left gonadal vein dilation as a critical vascular consideration prior to lateral lumbar interbody fusion: illustrative case.

Authors

Liam P Hughes, Joseph M White, Louis Chang

Published in

Journal of neurosurgery. Case lessons. Volume 11. Issue 26. Jun 29, 2026. Epub Jun 29, 2026.

Abstract

Lateral lumbar interbody fusion (LLIF) is a minimally invasive spinal fusion technique utilizing a lateral transpsoas approach to access the anterior column of the spine. Vascular injury is a rare complication but difficult to manage due to the minimally invasive nature of the procedure, making it critical to carefully review preoperative imaging prior to committing to a lateral approach.
A 67-year-old female presented with progressive low back pain and left lower extremity pain and sensory changes. MRI showed a grade 1 L4-5 spondylolisthesis with left-sided neuroforaminal stenosis. The patient was recommended for LLIF; however, on further review of the MRI findings, an abnormally dilated left gonadal vein (GV) was identified along the psoas muscle. Subsequent imaging revealed compression of the left renal vein between the superior mesenteric artery and aorta, causing venous outflow obstruction. Therefore, the surgical approach was changed to avoid potential vascular complications.
GV injury is a rare but major complication of lateral spine surgery. This case highlights the importance of careful preoperative imaging and anatomical review as lateral approaches become more common, and acts as a cautionary report for vascular review prior to LLIF. https://thejns.org/doi/10.3171/CASE26180.

PMID:
42372313
Bibliographic data and abstract were imported from PubMed on 30 Jun 2026.

Read full publication at:
Please sign in to see all details.

Stats

1-terrible, 9-excellent. How would you rate this publication? Sign in in to submit your rating.

Post a comment

You need to be signed in to post comments. You can sign in here.

Comments

There are no comments yet.