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Complications from minimally invasive lumbar interbody fusion: Experience from 100 patients

  • Antonio Tsahtsarlis
    Affiliations
    Brisbane Clinical Neuroscience Centre, Mater Private Hospital, South Brisbane, Queensland, Australia
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  • Johnny L. Efendy
    Affiliations
    Department of Neurosurgery, Princess Alexandra Hospital, Ipswich Road, Woolloongabba, Queensland, Australia
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  • Richard J. Mannion
    Affiliations
    Department of Neurosurgery, Princess Alexandra Hospital, Ipswich Road, Woolloongabba, Queensland, Australia

    Cambridge University Hospitals NHS Trust, Cambridge, UK
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  • Martin J. Wood
    Correspondence
    Corresponding author at: Mater Private Clinic, Suite 5.02, 550 Stanley Street, South Brisbane, Queensland 4101, Australia. Tel.: +61 7 3163 2830; fax: +61 7 3163 2829.
    Affiliations
    Brisbane Clinical Neuroscience Centre, Mater Private Hospital, South Brisbane, Queensland, Australia

    Department of Neurosurgery, Princess Alexandra Hospital, Ipswich Road, Woolloongabba, Queensland, Australia
    Search for articles by this author

      Abstract

      Minimally invasive lumbar fusion is well described and is reported to offer significant advantages to patients in terms of blood loss, a reduction in post-operative pain and a quicker recovery. However, this technique may expose patients to a greater risk of complications when compared to open lumbar instrumented fusion that may negate these advantages. Between January 2007 and March 2001, we conducted a prospective observational study of 100 consecutive patients (48 males and 52 females, mean age of 54 years) to investigate complications occurring from minimally invasive lumbar interbody fusion surgery using an image-guided technique. All patients underwent post-operative CT scans to assess implant placement. Scanning was repeated at 6 months to assess bony fusion. We observed the following complications: 2.5% (11/435) pedicle screw misplacement, 1.7% (2/120) interbody cage misplacement; 0.8% (1/120) interbody cage migration; 0.8% (1/120) patients requiring a post-operative blood transfusion; 2% (2/100) venous thrombo-embolism and 3% (3/100) patients with complications thought to be related to the use of bone morphogenic protein. There were no occurrences of infection and no cerebrospinal fluid leaks. We concluded that the rate of complications from minimally invasive lumbar interbody fusion is low, and compares favourably with the rates of complication from open procedures. Moreover, computerised navigation systems can be used in place of real-time fluoroscopy to guide implant placement, without an increase in the rate of complications.

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      References

        • Khoo L.T.
        • Palmer S.
        • Laich D.T.
        • et al.
        Minimally invasive percutaneous posterior lumbar interbody fusion.
        J Neurosurg Spine. 2002; 51: S166-S181
        • Foley K.T.
        • Holly L.T.
        • Schwender J.D.
        Minimally invasive lumbar fusion.
        Spine. 2003; 28: s26-s35
        • Isaacs R.E.
        • Podichetty V.K.
        • Santiago P.
        • et al.
        Minimally invasive microendoscopy-assisted transforaminal interbody fusion with instrumentation.
        J Neurosurg Spine. 2005; 3: 98-105
        • Schwender J.D.
        • Holly L.T.
        • Rouben D.P.
        • et al.
        Minimally invasive transforaminal lumbar interbody fusion (TLIF): technical feasibility and initial results.
        J Spinal Disord Tech. 2005; 18: S1-S6
        • Holly L.T.
        • Schwender J.D.
        • Rouben D.P.
        • et al.
        Minimally invasive transforaminal lumbar interbody fusion: indications, technique, and complications.
        Neurosurg Focus. 2006; 20: E6
        • Park Y.
        • Ha J.W.
        Comparison of one level posterior lumbar interbody fusion performed with a minimally approach or a traditional open approach.
        Spine. 2007; 32: 537-543
        • Shunwu F.
        • Xing Z.
        • Fengdong Z.
        • et al.
        Minimally invasive transforaminal lumbar interbody fusion for the treatment of degenerative lumbar diseases.
        Spine. 2010; 35: 1615-1620
        • Wood M.
        • Mannion R.
        Improving accuracy and reducing radiation exposure in minimally invasive lumbar interbody fusion.
        J Neurosurg Spine. 2010; 12: 533-539
        • Fritzell P.
        • Hagg O.
        • Nordwall A.
        Complications in lumbar fusion surgery for chronic low back pain: comparison of three surgical techniques used in a prospective randomized study. A report from the Swedish Lumbar Spine Study Group.
        Eur Spine J. 2003; 12: 178-189
        • Bjarke Christensen F.
        Lumbar spinal fusion. Outcome in relation to surgical methods, choice of implant and postoperative rehabilitation.
        Acta Orthop Scand Suppl. 2004; 75: 2-43
        • Bjarke Christensen F.
        • Stender Hansen E.
        • Laursen M.
        • et al.
        Long-term functional outcome of pedicle screw instrumentation as a support for posterolateral spinal fusion: randomized clinical study with a 5-year follow-up.
        Spine. 2002; 27: 1269-1277
        • Stevens K.J.
        • Spenciner D.B.
        • Griffith K.L.
        • et al.
        Comparison of minimally invasive and conventional open posterorlateral lumbar fusion using magnetic resonance imaging and retraction pressure studies.
        J Spinal Disord Tech. 2006; 19: 77-86
        • Schizas C.
        • Tzinieris N.
        • Tsiridis E.
        • et al.
        Minimally invasive versus open transforaminal lumbar interbody fusion: evaluating initial experience.
        Int Orthop. 2009; 33: 1683-1688
        • Ntoukas V.
        • Muller A.
        Minimally invasive approach versus traditional open approach for one level posterior lumbar interbody fusion.
        Minim Invasive Neurosurg. 2010; 53: 21-24
        • Wang J.
        • Zhou Y.
        • Zhang Z.F.
        • et al.
        Comparison of one-level minimally invasive and open transforaminal lumbar interbody fusion in degenerative and isthmic spondylolisthesis grades 1 and 2.
        Eur Spine J. 2010; 19: 1780-1784
        • Schizas C.
        • Tzinieris N.
        • Tsiridis E.
        • et al.
        Minimally invasive versus open transforaminal lumbar interbody fusion: evaluating initial experience.
        Int Orthop. 2009; 33: 1683-1688