A comparison of complication rate between anterior and lateral approaches to the lumbar spine

Abstract

Aim. The aim of this study was to compare the complication rate of traditional minimally invasive anterior with the new minimally invasive lateral trans-psoatic retroperitoneal approaches to the intervertebral discs at levels T12-L5. Methods. A review of all cases of minimally invasive anterior (ALIF) and lateral (XLIF) intervertebral disc surgery at levels T12-L5, treated at the Department of Neurosurgery from January 1996 to September 2011. The ALIF group consisted of 120 and the XLIF group consisted of 88 patients. Preoperative diagnoses were: degenerative disc disease, failed back surgery syndrome, spondylolisthesis, retrolisthesis and posttraumatic disc injury. The surgical steps are described. All surgical intraoperative and postoperative complications directly related to the spinal surgery were prospectively documented. The outcome measure was rate of complications. Results. In the ALIF group there were no major complications, only 35 minor intra-and postoperative complications in 32 patients (26.6%). The main complication was lumbar post-sympathectomy syndrome in 19 patients (15.8%). In the XLIF group there were 26 complications in 22 patients (25%). One major intraoperative complication was partial and transient injury to the L5 nerve root (1.1%). There were 25 minor postoperative complications in the XLIF group in 21 patients (23.9%), mainly transient pain of the left groin or anterior thigh in 11 patients (12.5%) or numbness in the same dermatomas in 9 patients (10.2%). Statistically there was no difference between the ALIF and XLIF groups in complication rate. Conclusion. Anterolateral and lateral retroperitoneal minimally invasive approaches to levels T12-L5 disc spaces are safe procedures with only minor complications and one exception. The rate of complications was similar in both groups. In the case of ALIF, the particular complication was post-sympathectomy syndrome. The main complication of XLIF was transient nerve root injury in one patient due to underestimation of the procedure in the outset. Intraoperative neuromonitoring during XLIF surgery is fully recommended.

Perioperative outcomes in minimally invasive lumbar spine surgery: A systematic review

“…Hrabalek et al [27] reported a 0% transfusion use in the MIS XLIF and open ALIF cohorts. Rodgers's 2010 study, focusing on patients 80 years of age and older, reported no use of perioperative transfusion in MIS XLIF patients, but a 70% rate of transfusion in PLIF patients [12] .…”

“…Laminectomy: Unilateral laminectomy for bilateral decompression LSS, max 2 levels, no spondylolisthesis 27 27 Watanabe et al [16] 2011 Lumbar spinous process-splitting laminectomy Neurogenic claudication 22 19 Clinical case series Rahman et al [18] 2008 Laminectomy LSS, no discectomy 38 88 Nomura et al [19] 2014 Laminectomy: Spinous process-splitting laminectomy Spondylolisthesis, LSS due to herniation 124 -Parikh et al [20] 2008…”

“…-0 1 -14% ---Nomura et al [22] [23] 102 ± 44 -35 ± 76 -11% -2.1 2.2 Wada et al [24] 144 -60 -7% --- [27] 2014 XLIF Retrospective cohort, XLIF vs ALIF DDD, FBSS, spondylolisthesis 88 120 Smith et al [28] 2012 XLIF Retrospective cohort, XLIF vs ALIF DDD, LSS, FBSS, spondylolisthesis, herniation 115 87 1 Rodgers et al [12] 2010 XLIF Retrospective cohort, XLIF vs PLIF > 80 yr, LSS, FBSS spondylolisthesis, scoliosis, fracture 40 20 Huang et al [29] 2010 MIS-ALIF 2 Prospective cohort, MIS-ALIF vs ALIF Not defined 10 13 Case series 3 Rodgers et al [13] 2011 XLIF PCS LSS, DDD, FBSS, spondylolisthesis, scoliosis 600 -Ruetten et al [30] 2005 XLIF RCS Lumbar disc prolapse 463 -Lykissas et al [31] 2014 XLIF RCS Degenerative spinal conditions 144 -Grimm et al [32] 2014 XLIF RCS DDD, LSS, FBSS, scoliosis, spondylolisthesis, herniation 108 -Tohmeh et al [33] 2011 XLIF PCS LSS, DDD, spondylolisthesis, spondylosis, scoliosis, recurrent herniation, ASD…”

“…Marchi et al [35] 2012 XLIF PCS Spondylolisthesis 52 -Sharma et al [36] 2011 XLIF RCS Spondylosis ± listhesis, scoliosis 43 -Pimenta et al [25] 2011 XLIF PCS DDD 36 -Ahmadian et al [37] 2013 XLIF RCS L4/L5 spondylolisthesis 31 -Caputo et al [38] 2012 XLIF PCS Scoliosis 30 -Malham et al [39] 2012 XLIF PCS DDD, spondylolisthesis, scoliosis 30 - 4 Pimenta et al [40] 2013 XLIF RCT L4/L5 DDD 30 -Elowitz et al [41] 2011 XLIF PCS LSS 25 -Oliveira et al [42] [27] ----28% 24% --Smith et al [28] 112 ± 31 173 ± 31 90 ± 74 311 ± 370 3% 6% 1.7 ± 1.3 3.6 ± 0.9 Rodgers et al [12] --1.4 g Hb 2.7 g Hb --1.3 5.3 Huang et al [29] 176 ± 8 202 ± 15 572 ± 93 970 ± 209 --11.6 ± 1.3 12.5 ± 1.3 Case series Rodgers et al [13] --1.38 g Hb -1% -1.2 -Ruetten et al [30] …”

Comparison of ALIF vs. XLIF for L4/5 interbody fusion: pros, cons, and literature review

“…General complication rates appear similar between ALIF (26.6%) and XLIF (25%) approaches (39). However, approach-related complication profiles differ slightly depending on the technique utilized.…”