An Institutional Six-year Trend Analysis of the Neurological Outcome After Lateral Lumbar Interbody Fusion

Aichmair, Alexander; Lykissas, Marios G.; Girardi, Federico P.; Sama, Andrew A.; Lebl, Darren R.; Taher, Fadi; Cammisa, Frank P.; Hughes, Alexander P.

doi:10.1097/brs.0b013e3182a3d1b4

Cited by 45 publications

(15 citation statements)

References 16 publications

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“…During a 6-year time period of performing LLIF at our institution, we noted a learning curve with a decreasing proportional trend for anterior thigh pain, sensory as well as motor deficits [42]. Le et al also observed a learning curve with a significant reduction in the incidence of postoperative thigh numbness during a 3-year period (from 26.1 to 10.7%) [43].…”

Section: Neurologic Injurymentioning

confidence: 79%

Lateral Lumbar Interbody Fusion—Outcomes and Complications

Salzmann

Shue

Hughes

2017

Curr Rev Musculoskelet Med

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116

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Purpose of Review Lateral lumbar interbody fusion (LLIF) is a relatively new, minimally invasive technique for interbody fusion. The goal of this review is to provide a general overview of LLIF with a special focus on outcomes and complications. Recent Findings Since the first description of the technique in 2006, the indications for LLIF have expanded and the rate of LLIF procedures performed in the USA has increased. LLIF has several theoretical advantages compared to other approaches including the preservation of the anterior and posterior annular/ligamentous structures, insertion of wide cages resting on the dense apophyseal ring bilaterally, and augmentation of disc height with indirect decompression of neural elements. Favorable long-term outcomes and a reduced risk of visceral/vascular injuries, incidental dural tears, and perioperative infections have been reported. However, approach-related complications such as motor and sensory deficits remain a concern. Summary In well-indicated patients, LLIF can be a safe procedure used for a variety of indications.

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Section: Neurologic Injurymentioning

confidence: 79%

Lateral Lumbar Interbody Fusion—Outcomes and Complications

Salzmann

Shue

Hughes

2017

Curr Rev Musculoskelet Med

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116

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“…Table 4 implies a lieterature review of neurological complications compared with TLIF and D/XLIF. 20, [25][26][27][28][29][30][31][32] The review indicates that OLIF has the least possible incidence in postoperative sensory and temporary motor weakness (13.5%), and permanent neurological deficit (1.2%). Considering the permanent neurological deficit in the current study was due to irregular manipulation in the early phase after the introduction of OLIF surgery, which can be considered to be the safer procedure compared with other interbody fusion procedures.Thus, D/XLIF mandatory requires intraoperative real-time electromyography (EMG) monitoring to avoid such neuronal damage; however, it is not enough to avoid neurological complication damage.…”

Section: Discussionmentioning

confidence: 99%

Perioperative Complications in 155 Patients Who Underwent Oblique Lateral Interbody Fusion Surgery

Abe

Orita

Mannoji

et al. 2017

Spine

216

143

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“…Aichmair et al reported sensory deficits in 78.8% of patients and transient neurological deficits in 21.8% of patients with LLIF. 6 Other studies have suggested that transient thigh numbness and mild hip flexion weakness are a result of the surgical technique of LLIF and should not be considered a complication. 74 Most reports showed these deficits to be temporary and not morbid, although Lykissas et al did note a 6.7% rate of permanent neurological deficit.…”

Section: Discussionmentioning

confidence: 99%

Comparison of complication rates of minimally invasive transforaminal lumbar interbody fusion and lateral lumbar interbody fusion: a systematic review of the literature

Joseph¹,

Smith²,

Marca³

et al. 2015

FOC

135

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OBJECT Minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) and lateral lumbar interbody fusion (LLIF) are 2 currently popular techniques for lumbar arthrodesis. The authors compare the total risk of each procedure, along with other important complication outcomes. METHODS This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Relevant studies (up to May 2015) that reported complications of either MI-TLIF or LLIF were identified from a search in the PubMed database. The primary outcome was overall risk of complication per patient. Secondary outcomes included risks of sensory deficits, temporary neurological deficit, permanent neurological deficit, intraoperative complications, medical complications, wound complications, hardware failure, subsidence, and reoperation. RESULTS Fifty-four studies were included for analysis of MI-TLIF, and 42 studies were included for analysis of LLIF. Overall, there were 9714 patients (5454 in the MI-TLIF group and 4260 in the LLIF group) with 13,230 levels fused (6040 in the MI-TLIF group and 7190 in the LLIF group). A total of 1045 complications in the MI-TLIF group and 1339 complications in the LLIF group were reported. The total complication rate per patient was 19.2% in the MI-TLIF group and 31.4% in the LLIF group (p < 0.0001). The rate of sensory deficits and temporary neurological deficits, and permanent neurological deficits was 20.16%, 2.22%, and 1.01% for MI-TLIF versus 27.08%, 9.40%, and 2.46% for LLIF, respectively (p < 0.0001, p < 0.0001, p = 0.002, respectively). Rates of intraoperative and wound complications were 3.57% and 1.63% for MI-TLIF compared with 1.93% and 0.80% for LLIF, respectively (p = 0.0003 and p = 0.034, respectively). No significant differences were noted for medical complications or reoperation. CONCLUSIONS While there was a higher overall complication rate with LLIF, MI-TLIF and LLIF both have acceptable complication profiles. LLIF had higher rates of sensory as well as temporary and permanent neurological symptoms, although rates of intraoperative and wound complications were less than MI-TLIF. Larger, prospective comparative studies are needed to confirm these findings as the current literature is of relative poor quality.

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An Institutional Six-year Trend Analysis of the Neurological Outcome After Lateral Lumbar Interbody Fusion

Cited by 45 publications

References 16 publications

Lateral Lumbar Interbody Fusion—Outcomes and Complications

Lateral Lumbar Interbody Fusion—Outcomes and Complications

Perioperative Complications in 155 Patients Who Underwent Oblique Lateral Interbody Fusion Surgery

Comparison of complication rates of minimally invasive transforaminal lumbar interbody fusion and lateral lumbar interbody fusion: a systematic review of the literature

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