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OBJECTIVE  Nerve root injuries associated with anterior lumbar interbody fusion (ALIF) are uncommonly reported in the literature. This case series and review aims to describe the etiology of L5 nerve root injury following ALIF at L5–S1.    METHODS  The authors performed a single-center retrospective review of prospectively collected data of patients who underwent surgery between 2017 and 2019 who had postoperative L5 nerve root injuries after stand-alone L5–S1 ALIF. They also reviewed the literature with regard to nerve root injuries after ALIF procedures.    RESULTS  The authors report on 3 patients with postoperative L5 radiculopathy. All 3 patients had pain that improved. Two of the 3 patients had a neurological deficit, one of which improved.    CONCLUSIONS  Stretch neuropraxia from overdistraction is an important cause of postoperative L5 radiculopathy after L5–S1 ALIF. Judicious use of implants and careful preoperative planning to determine optimal implant sizes are paramount.

Vulnerability of the L5 nerve root during anterior lumbar interbody fusion at L5–S1: case series and review of the literature