Prolonged Neuromuscular Paralysis Following Succinylcholine Induction Leading to a Trans-Kambin Oblique Lateral Lumbar Interbody Fusion (OLLIF) Procedure Performed Without Neuromonitoring

Intraoperative neuromonitoring (IONM) is widely used during minimally invasive spine procedures, including trans-Kambin oblique lateral lumbar interbody fusion, to reduce the risk of neural injury. We present a unique case in which prolonged neuromuscular paralysis following succinylcholine induction resulted in the absence of effective neuromonitoring. After careful multidisciplinary consideration of case cancellation and a detailed risk-benefit assessment, the procedure was completed because it involved a single level without complicating anatomical factors. The patient experienced an excellent clinical outcome with no postoperative neurological deficit. This case highlights important anesthetic considerations, potential pharmacogenetic variability, and nuanced intraoperative decision-making when neuromonitoring becomes unexpectedly unavailable.