Complication avoidance and management in anterior lumbar interbody fusion

Than, Khoi D.; Wang, Anthony; Rahman, Siamak; Wilson, Thomas J.; Valdivia, Juan; Park, Paul; Marca, Frank La

doi:10.3171/2011.7.focus11141

Cited by 85 publications

(47 citation statements)

References 89 publications

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“…20, 21,23,34 However, these new techniques were not without problems, such as an increased risk of retrograde ejaculation with laparoscope-assisted anterior lumbar interbody fusions (ALIFs) 28 or inadequate restoration of foraminal height and lordosis with transforaminal interbody fusion. 13 Given the aforementioned advantages of an interbody fusion at L5-S1 and the complications associated with traditional approaches, a new minimally invasive technique was designed to use the anatomical tissue plane separating the sacrum from the peritoneal contents.…”

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confidence: 99%

Axial interbody arthrodesis of the L5–S1 segment: a systematic review of the literature

Schroeder¹,

Kepler²,

MBA³

et al. 2015

SPI

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OBJECT The object of this study was to determine the fusion rate and safety profile of an axial interbody arthrodesis of the L5–S1 motion segment. METHODS A systematic search of MEDLINE was conducted for literature published between January 1, 2000, and August 17, 2014. All peer-reviewed articles related to the fusion rate of L5–S1 and the safety profile of an axial interbody arthrodesis were evaluated. RESULTS Seventy-four articles were identified, but only 15 (13 case series and 2 retrospective cohort studies) met the study inclusion criteria. The overall pseudarthrosis rate at L5–S1 was 6.9%, and the rate of all other complications was 12.9%. A total of 14.4% of patients required additional surgery, and the infection rate was 5.4%. Deformity studies reported a significantly increased rate of complications (46.3%), and prospectively collected data demonstrated significantly higher complication (36.8%) and revision (22.6%) rates. Lastly, studies with a conflict of interest reported lower complication rates (12.4%). CONCLUSIONS A systematic review of the literature indicates that an axial interbody fusion performed at the lumbosacral junction is associated with a high fusion rate (93.15%) and an acceptable complication rate (12.90%). However, these results are based mainly on retrospective case series by authors with a conflict of interest. The limited prospective data available indicate that the actual fusion rate may be lower and the complication rate may be higher than currently reported.

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mentioning

confidence: 99%

Axial interbody arthrodesis of the L5–S1 segment: a systematic review of the literature

Schroeder¹,

Kepler²,

MBA³

et al. 2015

SPI

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“…3,16,20,30 Posterior approaches necessitate relatively extensive muscle dissection and removal of posterior elements, which can further compromise spinal stability.…”

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confidence: 99%

Minimally invasive lateral retroperitoneal transpsoas interbody fusion for L4–5 spondylolisthesis: clinical outcomes

Ahmadian

Verma

Oskouian

et al. 2013

SPI

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Object In this study the authors report on the clinical outcomes, safety, and efficacy of lateral retroperitoneal transpsoas minimally invasive surgery–lumbar interbody fusion (MIS-LIF) at the L4–5 disc space in patients with spondylolisthesis. This approach has become an increasingly popular means of fusion. Its most frequent complication is lumbar plexus injury. Reported complication rates at the L4–5 disc space vary widely in the literature, bringing into question the safety of MIS-LIF for the L4–5 region, especially in patients with spondylolisthesis. Methods The authors retrospectively reviewed prospectively acquired multicenter databases of patients with Grade I and II L4–5 spondylolisthesis who had undergone elective MIS-LIF between 2008 and 2011. Clinical follow-up had been scheduled for 1, 3, 6, 12, and 24 months postoperatively. Outcome measures included estimated blood loss, operative time, length of hospital stay, integrity of construct, complications, fusion rates, visual analog scale (VAS), Oswestry Disability Index (ODI), and 36-Item Short Form Health Survey (SF-36). Results Eighty-four patients with L4–5 MIS-LIF were identified, 31 of whom met the study inclusion criteria: 26 adults with Grade I and 5 adults with Grade II L4–5 spondylolisthesis who had undergone elective MIS-LIF and subsequent posterior percutaneous pedicle screw fixation without surgical manipulation of the posterior elements (laminectomy, foraminotomy, facetectomy). The study cohort consisted of 9 males (29%) and 22 females (71%) with an average age of 61.5 years. The mean total blood loss was 94 ml (range 20–250 ml). The mean hospital stay and follow-up were 3.5 days and 18.2 months, respectively. The average score on the ODI improved from 50.4 preoperatively to 30.9 at the last follow-up (p < 0.0001). The SF-36 score improved from 38.1 preoperatively to 59.5 at the last follow-up (p < 0.0001). The VAS score improved from 69.9 preoperatively to 38.7 at the last follow-up (p < 0.0001). No motor weakness or permanent deficits were documented in any patient. Correction of deformity did not have any neurological complications. All patients had improvement in anterolisthesis. Residual postoperative listhesis across cases was noted in 4 patients (12.9%). Transient anterior thigh numbness (Sensory Dermal Zone III) was noted in 22.5% of patients. Conclusions With its established surgical corridors through the retroperitoneum and psoas muscle, the MIS-LIF combined with posterior percutaneous pedicle screw fixation/reduction is a safe, reproducible, and effective technique for patients with symptomatic degenerative spondylolisthesis at the L4–5 vertebral segment.

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“…Here, the RE rate in the BMP group was higher than in the control group (7.9 % versus 1.4 %) [7]. The laparoscopic surgical technique in itself has been shown to increase the risk for RE, so that it cannot be directly blamed on BMP [38,40,41].…”

Section: Resultsmentioning

confidence: 93%

Bone morphogenetic protein use in spine surgery—complications and outcomes: a systematic review

Faúndez

Tournier

Garcia

et al. 2016

International Orthopaedics (SICOT)

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This literature review confirms that the use of rhBMP-2 following FDA-approved recommendations (i.e. one-level ALIF surgery with an LT-cage) is safe. The rate of complications is low and the AEs had been identified by the FDA during the pre-marketing clinical trials. The clinical efficiency of rhBMP-2 is equal or superior to that of allogenic or autologous bone graft in respect to fusion rate, low back pain disability, patient satisfaction and rate of re-operations. For all other off-label use, the safety and effectiveness of rhBMP-2 have not been established, and further RCTs with high level of evidence are required.

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Complication avoidance and management in anterior lumbar interbody fusion

Cited by 85 publications

References 89 publications

Axial interbody arthrodesis of the L5–S1 segment: a systematic review of the literature

Axial interbody arthrodesis of the L5–S1 segment: a systematic review of the literature

Minimally invasive lateral retroperitoneal transpsoas interbody fusion for L4–5 spondylolisthesis: clinical outcomes

Bone morphogenetic protein use in spine surgery—complications and outcomes: a systematic review

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