Towards a More Realistic Appraisal of Complications Following Staged Lateral Lumbar Interbody Fusion: A Single Institution Series

Abstract

Study Design Retrospective cohort study. Objectives With steadily increasing implementation of far lateral approaches in spine surgery, surgeons can utilize the advantages of different approaches synergistically to ensure an optimal patient outcome. Our single institution study aimed to assess the complication rates of patients who underwent a lateral interbody fusion as the index procedure and additional anterior or posterior instrumentation as part of a planned staged surgical reconstruction effort. Methods This study was approved by our institutional review board (STUDY2021000113). We included 576 patients who received a lateral lumbar interbody fusion (LLIF) as the index procedure followed by transforaminal lumbar interbody fusion (TLIF), posterior lumbar interbody fusion (PLIF) or anterior lumbar interbody fusion (ALIF) between 2016 and 2020. Primary outcomes were complications identified during the initial inpatient stay, which were categorized into approach-related and secondary complications. Secondary outcomes tracked up to 6 years post-surgery. Results The overall complication rate was 19.2% (10.5% approach related, 8.7% secondary complications). Significant intraoperative hemorrhage (mean 659.3 mL vs 131.4 mL, P < .01) was the most common approach related complication with an incidence of 4%, followed by temporary hip flexor weakness in 2.6%. A permanent (femoral) nerve damage was verified in 1 patient. The most common secondary complication was impaired wound healing in 12 patients (2.1%). We identified a 7.1% (41 of 576 patients) rate of revision surgery, on average after 372 days (±34 days). Conclusions We recorded an overall complication rate of 19.2% for staged adult deformity corrective surgeries utilizing far lateral interbody fusions at several lumbar levels followed by a more comprehensive posterior surgical reconstruction.

Insufficient sagittal endplate-bone graft contact is a risk factor for high-grade cage subsidence occurring after lateral lumbar interbody fusion supplemented with lateral plate: An analysis of 122 cases

“…LLIF is a minimally invasive technique developed in order to circumvent the complications associated with traditional anterior or posterior approaches for lumbar interbody fusion [1,2]. Despite the cages used in the LLIF procedure are large and generally span the apophyseal ring, the reported incidence of cage subsidence range from 7.2-42.0% [16,[18][19][20].…”

“…Lumbar interbody fusion has become a standard procedure for patients with degenerative lumbar diseases when conservative treatments have proved to be ineffective. Minimally invasive lateral lumbar interbody fusion (LLIF) circumvents the need for dissection of posterior anatomical structures, such as ligaments and paravertebral muscles, essential in posterior or transforaminal lumbar interbody fusion [1,2]. Consequently, LLIF presents several advantages, including reduced operative time, diminished surgical trauma and blood loss, and reduced risk of direct neural injury when compared to posterior/transforaminal lumbar interbody fusion [3,4].…”