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

Abstract

<jats:sec> <jats:title>OBJECT</jats:title> <jats:p>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.</jats:p></jats:sec> <jats:sec> <jats:title>METHODS</jats:title> <jats:p>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.</jats:p></jats:sec> <jats:sec> <jats:title>RESULTS</jats:title> <jats:p>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 &lt; 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 &lt; 0.0001, p &lt; 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.</jats:p></jats:sec> <jats:sec> <jats:title>CONCLUSIONS</jats:title> <jats:p>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.</jats:p></jats:sec>

Anterior and Lateral Lumbar Interbody Fusion With Supplemental Interspinous Process Fixation: Outcomes from a Multicenter, Prospective, Randomized, Controlled Study

“…[1][2][3][4][5][6][7][8][9][10][11][12] However, given the inherent axial and coronal stability of a large anterolateral cage, the structural necessity of invasive/extensive PSF in ALIF/LLIF has come into question, particularly in single-level application. Accordingly, a growing body of literature exploring less invasive and less demanding alternatives for secondary stability in ALIF/LLIF has emerged.…”

Stereotactic navigation for the prepsoas oblique lateral lumbar interbody fusion: technical note and case series

“…A meta-analysis by Joseph et al showed a 9.4% rate of temporary and 2.5% rate of permanent neurological deficits with the transpsoas lateral approach. 5 In that meta-analysis, there was a 27.1% rate of sensory deficits. Pseudohernia has been described after the lateral approach.…”

Evaluation of the location of intervertebral cages during oblique lateral interbody fusion surgery to achieve sagittal correction

“…Two popular and common LLIF procedures are oblique lateral interbody fusion (OLIF) and extreme lateral interbody fusion (XLIF), which each require specially designed instruments [12][13][14][15] . OLIF, especially, enables surgeons to easily and less invasively access the vacant oblique corridor in front of the psoas muscles without causing any splitting, which occurs with XLIF 16,17) . The lateral interbody fusion cage for OLIF has a lordotic angle of 6 .…”