Perioperative complications of primary posterior lumbar interbody fusion for nonisthmic spondylolisthesis: analysis of risk factors

Abstract

<jats:sec> <jats:title>Object</jats:title> <jats:p>Although posterior lumbar interbody fusion (PLIF) is an excellent procedure to attain circumferential decompression, it is technically demanding and can lead to various surgical complications. The authors retrospectively reviewed consecutive patients with nonisthmic spondylolisthesis who underwent PLIF to reveal the incidence and risk factors for perioperative complications of PLIF.</jats:p></jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>A total of 240 patients underwent PLIF. The fusion level was at L4–5 in 220, L3–4 in 18, and L5–S1 in 2. The medial walls of the fusion segment's facet joints were resected, and the VSP Spine System was used for the pedicle screw instrumentation. The operations were performed by 7 surgeons, who were divided into 4 groups according to their level of experience with spinal surgery.</jats:p></jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>The average operation time was 175 ± 49 minutes, and the estimated blood loss was 746 ± 489 ml. A total of 90 patients (37.5%) experienced complications; 41 (17%) experienced transient neurological complications, and 18 (7.5%) experienced permanent neurological complications. The mean neurological score according to the Japanese Orthopaedic Association improved from 14.3 ± 3.8 to 24.7 ± 4.0 in the patients without complications and from 14.8 ± 3.6 to 24.0 ± 3.9 in the patients with complications. Multivariate analysis concerning the relationship between complications and risk factors (operation time, estimated intraoperative blood loss, and surgeon experience) revealed that operation time was the only significant risk factor for complications.</jats:p></jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>Perioperative complications of PLIF were more frequent in this homogeneous study group than in other studies of various implants. Total excision of the facet joints might preclude neurological complications.</jats:p></jats:sec>

Medium-term Clinical Results of Microsurgical Lumbar Flavectomy That Preserves Facet Joints in Cases of Lumbar Degenerative Spondylolisthesis

“…The JOA score before surgery was 13.6 ± 3.8 (7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19) in the BL group and 13.6 ± 3.0 (9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22) in the BDU group. The mean There were no significant differences in the JOA scores between the 2 groups.…”

“…Preoperative JOA score 13.6 ± 3.8 (7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19) 13.6 ± 3.0 (9-22) Low back pain 1.5 ± 0.6 (0-3) 1.5 ± 0.7 (1-3) Leg pain 0.9 ± 0.3 (0-1) 0.9 ± 0.6 (0-2) Gait 0.8 ± 0.4 (0-1) 0.8 ± 0.5 (0-2) Postoperative JOA score 24.7 ± 3.6 (16-29)z 23.9 ± 4.3 (16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29) *Data are shown as mean ± SD (range).…”

“…[12][13][14][15][16][17] This procedure is considered ideal because it provides a better long-term outcome for spondylolisthesis than decompression alone. 18 However, a high reoperation rate and the risk of spinal fusion in the case of lumbar degenerative disease have been reported, 18,[19][20][21] and instrumentation surgery costs more than noninstrumentation surgery. 22 Alternatively, minimally invasive procedures have been used for lumbar degenerative canal stenosis, and these procedures have shown favorable outcomes.…”

Transforaminal lumbar interbody fusion for traumatic lumbar spondylolisthesis

“…For performing lumbar interbody fusion, the posterior approach to the spine has advantages over an anterior approach in that the risk of damaging retroperitoneal structures is lower and spinal disorder at lower lumbar levels can be managed via one approach, thus providing versatility1 [18][19] . Although the posterior lumbar interbody fusion(PLIF) procedure is useful in many cases such as spinal stenosis, instability, spodylolisthesis, and spondylolysis and so on, there are some complications such as nerve damage or neurogenic pain when the surgeon retracts the dural sheath out of the midline to obtain unobstructed access to the disc [20][21][22] . The TLIF procedure was developed in attempt to alleviate many of the complications related to the PLIF technique.…”

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“…As a result, it is associated with higher risks of cerebrospinal fluid leakage, dysesthetic nerve pain syndrome, nerve root injury, epidural fibrosis, as well as cage migration [9][10][11].In our study, multivariate analysis was used to account for potential covariates and identify factors associated with an increased complication risk -the only peri-operative complications occurred in the PLIF group, with 2 cases of dural tears, 2 cases of epidural hematomas, and 2 cases of dysesthetic nerve pain syndrome secondary to genitofemoral nerve injury.…”