Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
European Spine Journal
Published in: European Spine Journal 3/2015

01-04-2015 | Original Article

Visceral, vascular, and wound complications following over 13,000 lateral interbody fusions: a survey study and literature review

Authors: Juan S. Uribe, Armen R. Deukmedjian

Published in: European Spine Journal | Special Issue 3/2015

Login to get access

Abstract

Purpose

Minimally invasive lateral interbody fusion (MIS-LIF) has become a popular less invasive treatment option for degenerative spinal disease, deformity, and trauma. While MIS-LIF offers several advantages over traditional anterior and posterior approaches, the procedure is not without risk. The purpose of this study was to evaluate the incidence of visceral, vascular, and wound complications following MIS-LIF performed by experienced surgeons.

Methods

A survey was conducted by experienced (more than 100 case experience) MIS-LIF surgeons active in the society of lateral access surgery (SOLAS) to collect data on wound infections and visceral and vascular injuries. Of 77 spine surgeons surveyed, 40 (52 %) responded, including 25 (63 %) orthopedic surgeons and 15 (38 %) neurosurgeons, with 20 % practicing at an academic institution and 80 % in community practice.

Results

Between 2003 and 2013, 13,004 patients were treated with MIS-LIF by the 40 surgeons who responded to the survey. Of those patients, 0.08 % experienced a visceral complication (bowel injury), 0.10 % experienced a vascular injury, 0.27 % experienced a superficial wound infection, and 0.14 % experienced a deep wound infection.

Conclusion

The incidence of surgical site infections and vascular and visceral complications following MIS-LIF in this large series was low and compared favorably with rates for alternative interbody fusion approaches. Although technically demanding, MIS-LIF is a reproducible approach for interbody fusion with a low risk of vascular and visceral complications and infections.
Literature
1.
Brau SA (2002) Mini-open approach to the spine for anterior lumbar interbody fusion: description of the procedure, results and complications. Spine J 2:216–223CrossRefPubMed
2.
Crandall DG, Revella J (2009) Transforaminal lumbar interbody fusion versus anterior lumbar interbody fusion as an adjunct to posterior instrumented correction of degenerative lumbar scoliosis: three year clinical and radiographic outcomes. Spine 34:2126–2133CrossRefPubMed
3.
Hackenberg L, Halm H, Bullmann V, Vieth V, Schneider M, Liljenqvist U (2005) Transforaminal lumbar interbody fusion: a safe technique with satisfactory three to five year results. Eur Spine J 14:551–558CrossRefPubMedCentralPubMed
4.
Jiang SD, Chen JW, Jiang LS (2012) Which procedure is better for lumbar interbody fusion: anterior lumbar interbody fusion or transforaminal lumbar interbody fusion? Arch Orthop Trauma Surg 132:1259–1266CrossRefPubMed
5.
Karikari IO, Isaacs RE (2010) Minimally invasive transforaminal lumbar interbody fusion: a review of techniques and outcomes. Spine 35:S294–S301CrossRefPubMed
6.
Mehta VA, McGirt MJ, Garces Ambrossi GL et al (2011) Trans-foraminal versus posterior lumbar interbody fusion: comparison of surgical morbidity. Neurol Res 33:38–42CrossRefPubMed
7.
Mura PP, Costaglioli M, Piredda M, Caboni S, Casula S (2011) TLIF for symptomatic disc degeneration: a retrospective study of 100 patients. Eur Spine J 20(Suppl 1):S57–S60CrossRefPubMed
8.
Penta M, Fraser RD (1997) Anterior lumbar interbody fusion. A minimum 10-year follow-up. Spine 22:2429–2434CrossRefPubMed
9.
Poh SY, Yue WM, Chen LT, Guo CM, Yeo W, Tan SB (2011) Two-year outcomes of transforaminal lumbar interbody fusion. J Orthop Surg (Hong Kong) 19:135–140
10.
Baker JK, Reardon PR, Reardon MJ, Heggeness MH (1993) Vascular injury in anterior lumbar surgery. Spine 18:2227–2230CrossRefPubMed
11.
12.
Flynn JC, Price CT (1984) Sexual complications of anterior fusion of the lumbar spine. Spine 9:489–492CrossRefPubMed
13.
Garg J, Woo K, Hirsch J, Bruffey JD, Dilley RB (2010) Vascular complications of exposure for anterior lumbar interbody fusion. J Vasc Surg 51:946–950CrossRefPubMed
14.
Kulkarni SS, Lowery GL, Ross RE, Ravi SK, Lykomitros V (2003) Arterial complications following anterior lumbar interbody fusion: report of eight cases. Eur Spine J 12:48–54PubMed
15.
Lindley EM, McBeth ZL, Henry SE et al (2012) Retrograde ejaculation after anterior lumbar spine surgery. Spine 37:1785–1789CrossRefPubMed
16.
Sasso RC, Kenneth BJ, LeHuec JC (2003) Retrograde ejaculation after anterior lumbar interbody fusion: transperitoneal versus retroperitoneal exposure. Spine 28:1023–1026PubMed
17.
Wood KB, Devine J, Fischer D, Dettori JR, Janssen M (2010) Vascular injury in elective anterior lumbosacral surgery. Spine 35:S66–S75CrossRefPubMed
18.
Brau SA, Delamarter RB, Schiffman ML, Williams LA, Watkins RG (2004) Vascular injury during anterior lumbar surgery. Spine J 4:409–412CrossRefPubMed
19.
Szolar DH, Preidler KW, Steiner H et al (1996) Vascular complications in lumbar disk surgery: report of four cases. Neuroradiology 38:521–525CrossRefPubMed
20.
Cho KJ, Suk SI, Park SR et al (2007) Complications in posterior fusion and instrumentation for degenerative lumbar scoliosis. Spine 32:2232–2237CrossRefPubMed
21.
Khan IS, Sonig A, Thakur JD, Bollam P, Nanda A (2013) Perioperative complications in patients undergoing open transforaminal lumbar interbody fusion as a revision surgery. J Neurosurg Spine 18:260–264CrossRefPubMed
22.
Lee P, Fessler RG (2012) Perioperative and postoperative complications of single-level minimally invasive transforaminal lumbar interbody fusion in elderly adults. J Clin Neurosci 19:111–114CrossRefPubMed
23.
O’Toole JE, Eichholz KM, Fessler RG (2009) Surgical site infection rates after minimally invasive spinal surgery. J Neurosurg Spine 11:471–476CrossRefPubMed
24.
Parker SL, Adogwa O, Witham TF, Aaronson OS, Cheng J, McGirt MJ (2011) Post-operative infection after minimally invasive versus open transforaminal lumbar interbody fusion (TLIF): literature review and cost analysis. Minim Invasive Neurosurg 54:33–37CrossRefPubMed
25.
Potter BK, Freedman BA, Verwiebe EG, Hall JM, Polly DW Jr, Kuklo TR (2005) Transforaminal lumbar interbody fusion: clinical and radiographic results and complications in 100 consecutive patients. J Spinal Disord Tech 18:337–346CrossRefPubMed
26.
Salehi SA, Tawk R, Ganju A, LaMarca F, Liu JC, Ondra SL (2004) Transforaminal lumbar interbody fusion: surgical technique and results in 24 patients. Neurosurgery 54:368–374CrossRefPubMed
27.
Taneichi H, Suda K, Kajino T, Matsumura A, Moridaira H, Kaneda K (2006) Unilateral transforaminal lumbar interbody fusion and bilateral anterior-column fixation with two Brantigan I/F cages per level: clinical outcomes during a minimum 2-year follow-up period. J Neurosurg Spine 4:198–205CrossRefPubMed
28.
Papadoulas S, Konstantinou D, Kourea HP, Kritikos N, Haftouras N, Tsolakis JA (2002) Vascular injury complicating lumbar disc surgery. A systematic review. Eur J Vasc Endovasc Surg 24:189–195CrossRefPubMed
29.
Ozgur BM, Aryan HE, Pimenta L, Taylor WR (2006) Extreme Lateral Interbody Fusion (XLIF): a novel surgical technique for anterior lumbar interbody fusion. Spine J 6:435–443CrossRefPubMed
30.
Dakwar E, Cardona RF, Smith DA, Uribe JS (2010) Early outcomes and safety of the minimally invasive, lateral retroperitoneal transpsoas approach for adult degenerative scoliosis. Neurosurg Focus 28:E8CrossRefPubMed
31.
Deukmedjian AR, Le TV, Baaj AA, Dakwar E, Smith DA, Uribe JS (2012) Anterior longitudinal ligament release using the minimally invasive lateral retroperitoneal transpsoas approach: a cadaveric feasibility study and report of 4 clinical cases. J Neurosurg Spine 17:530–539CrossRefPubMed
32.
Le TV, Uribe JS (2014) The minimally invasive retroperitoneal transpsoas approach. In: Chung K (ed) Spine Surgery Rijeka Croatia. InTech, Croatia, pp 79–96
33.
Benglis DM, Elhammady MS, Levi AD, Vanni S (2008) Minimally invasive anterolateral approaches for the treatment of back pain and adult degenerative deformity. Neurosurgery 63:191–196CrossRefPubMed
34.
Eck JC, Hodges S, Humphreys SC (2007) Minimally invasive lumbar spinal fusion. J Am Acad Orthop Surg 15:321–329PubMed
35.
Wang MY, Ludwig SC, Anderson DG, Mummaneni PV (2008) Percutaneous iliac screw placement: description of a new minimally invasive technique. Neurosurg Focus 25:E17CrossRefPubMed
36.
Mummaneni PV, Tu TH, Ziewacz JE, Akinbo OC, Deviren V, Mundis GM (2013) The role of minimally invasive techniques in the treatment of adult spinal deformity. Neurosurg Clin N Am 24:231–248CrossRefPubMed
37.
Fessler RG, O’Toole JE, Eichholz KM, Perez-Cruet MJ (2006) The development of minimally invasive spine surgery. Neurosurg Clin N Am 17:401–409CrossRefPubMed
38.
Anand N, Baron EM, Thaiyananthan G, Khalsa K, Goldstein TB (2008) Minimally invasive multilevel percutaneous correction and fusion for adult lumbar degenerative scoliosis: a technique and feasibility study. J Spinal Disord Tech 21:459–467CrossRefPubMed
39.
40.
Deukmedjian AR, Le TV, Dakwar E, Martinez CR, Uribe JS (2012) Movement of abdominal structures on magnetic resonance imaging during positioning changes related to lateral lumbar spine surgery: a morphometric study: clinical article. J Neurosurg Spine 16:615–623CrossRefPubMed
41.
Peterson MD, Youssef J (2013) eXtreme Lateral Interbody Fusion (XLIF): lumbar surgical technique. In: Goodrich JA, Volcan IJ (eds) eXtreme Lateral Interbody Fusion (XLIF). Quality Medical Publishing, St. Louis, pp 159–178
42.
Tormenti MJ, Maserati MB, Bonfield CM, Okonkwo DO, Kanter AS (2010) Complications and radiographic correction in adult scoliosis following combined transpsoas extreme lateral interbody fusion and posterior pedicle screw instrumentation. Neurosurg Focus 28:E7CrossRefPubMed
43.
Assina R, Majmundar NJ, Herschman Y, Heary RF (2014) First report of major vascular injury due to lateral transpsoas approach leading to fatality. J Neurosurg Spine 21:794–798CrossRefPubMed
44.
Aichmair A, Fantini GA, Garvin S, Beckman J, Girardi FP (2015) Aortic perforation during lateral lumbar interbody fusion. J Spinal Disord Tech 28:71–75CrossRefPubMed
45.
Tohmeh AG, Rodgers WB, Peterson MD (2011) Dynamically evoked, discrete-threshold electromyography in the extreme lateral interbody fusion approach. J Neurosurg Spine 14:31–37CrossRefPubMed
46.
Kotwal S, Kawaguchi S, Lebl D et al (2012) Minimally invasive lateral lumbar interbody fusion: clinical and radiographic outcome at a minimum 2-year follow-up. J Spinal Disord Tech [Epub ahead of print]
47.
Khoo LT, Beisse R, Potulski M (2002) Thoracoscopic-assisted treatment of thoracic and lumbar fractures: a series of 371 consecutive cases. Neurosurgery 51:S104–S117PubMed
48.
Busse JW, Riva JJ, Rampersaud R et al (2014) Spine surgeons’ requirements for imaging at the time of referral: a survey of Canadian spine surgeons. Can J Surg 57:E25–E30CrossRefPubMedCentralPubMed
49.
Gautschi OP, Stienen MN, Smoll NR, Corniola MV, Tessitore E, Schaller K (2014) Incidental durotomy in lumbar spine surgery–a three-nation survey to evaluate its management. Acta Neurochir (Wien) 156:1813–1820CrossRef
50.
Carl AL, Kostuik J, Huckell CB, Abitbol JJ, Matsumoto M, Sieber A (2003) Surgeon perceptions of the complications and value of threaded fusion cages as a spine fusion technique: results of a consensus survey. Spine J 3:356–359CrossRefPubMed
51.
Fantini GA, Pappou IP, Girardi FP, Sandhu HS, Cammisa FP Jr (2007) Major vascular injury during anterior lumbar spinal surgery: incidence, risk factors, and management. Spine 32:2751–2758CrossRefPubMed
52.
Brau SA, Spoonamore MJ, Snyder L et al (2003) Nerve monitoring changes related to iliac artery compression during anterior lumbar spine surgery. Spine J 3:351–355CrossRefPubMed
53.
Hamdan AD, Malek JY, Schermerhorn ML, Aulivola B, Blattman SB, Pomposelli FB Jr (2008) Vascular injury during anterior exposure of the spine. J Vasc Surg 48:650–654CrossRefPubMed
54.
Hrabalek L, Adamus M, Wanek T, Machac J, Tucek P (2012) Surgical complications of the anterior approach to the L5/S1 intervertebral disc. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 156:354–358PubMed
55.
Inamasu J, Guiot BH (2006) Vascular injury and complication in neurosurgical spine surgery. Acta Neurochir (Wien) 148:375–387CrossRef
56.
Li J, Dumonski ML, Liu Q et al (2010) A multicenter study to evaluate the safety and efficacy of a stand-alone anterior carbon I/F Cage for anterior lumbar interbody fusion: two-year results from a Food and Drug Administration investigational device exemption clinical trial. Spine 35:E1564–E1570CrossRefPubMed
57.
Regan JJ, Aronoff RJ, Ohnmeiss DD, Sengupta DK (1999) Laparoscopic approach to L4-L5 for interbody fusion using BAK cages: experience in the first 58 cases. Spine 24:2171–2174CrossRefPubMed
58.
Scaduto AA, Gamradt SC, Yu WD, Huang J, Delamarter RB, Wang JC (2003) Perioperative complications of threaded cylindrical lumbar interbody fusion devices: anterior versus posterior approach. J Spinal Disord Tech 16:502–507CrossRefPubMed
59.
Faciszewski T, Winter RB, Lonstein JE, Denis F, Johnson L (1995) The surgical and medical perioperative complications of anterior spinal fusion surgery in the thoracic and lumbar spine in adults. A review of 1223 procedures. Spine 20:1592–1599CrossRefPubMed
60.
Zahradnik V, Lubelski D, Abdullah KG, Kelso R, Mroz T, Kashyap VS (2013) Vascular injuries during anterior exposure of the thoracolumbar spine. Ann Vasc Surg 27:306–313CrossRefPubMed
61.
Rajaraman V, Vingan R, Roth P, Heary RF, Conklin L, Jacobs GB (1999) Visceral and vascular complications resulting from anterior lumbar interbody fusion. J Neurosurg 91:60–64PubMed
62.
Rihn JA, Patel R, Makda J et al (2009) Complications associated with single-level transforaminal lumbar interbody fusion. Spine J 9:623–629CrossRefPubMed
63.
Villavicencio AT, Burneikiene S, Bulsara KR, Thramann JJ (2006) Perioperative complications in transforaminal lumbar interbody fusion versus anterior-posterior reconstruction for lumbar disc degeneration and instability. J Spinal Disord Tech 19:92–97CrossRefPubMed
64.
Smith DW, Lawrence BD (1991) Vascular complications of lumbar decompression laminectomy and foraminotomy. A unique case and review of the literature. Spine 16:387–390CrossRefPubMed
65.
Erkut B, Unlu Y, Kaygin MA, Colak A, Erdem AF (2007) Iatrogenic vascular injury during to lumbar disc surgery. Acta Neurochir (Wien) 149:511–515CrossRef
66.
Rivet DJ, Jeck D, Brennan J, Epstein A, Lauryssen C (2004) Clinical outcomes and complications associated with pedicle screw fixation-augmented lumbar interbody fusion. J Neurosurg Spine 1:261–266CrossRefPubMed
67.
Faundez AA, Schwender JD, Safriel Y et al (2009) Clinical and radiological outcome of anterior-posterior fusion versus transforaminal lumbar interbody fusion for symptomatic disc degeneration: a retrospective comparative study of 133 patients. Eur Spine J 18:203–211CrossRefPubMedCentralPubMed
68.
Smith AJ, Arginteanu M, Moore F, Steinberger A, Camins M (2010) Increased incidence of cage migration and nonunion in instrumented transforaminal lumbar interbody fusion with bioabsorbable cages. J Neurosurg Spine 13:388–393CrossRefPubMed
69.
Tormenti MJ, Maserati MB, Bonfield CM et al (2012) Perioperative surgical complications of transforaminal lumbar interbody fusion: a single-center experience. J Neurosurg Spine 16:44–50CrossRefPubMed
70.
Lau D, Lee JG, Han SJ, Lu DC, Chou D (2011) Complications and perioperative factors associated with learning the technique of minimally invasive transforaminal lumbar interbody fusion (TLIF). J Clin Neurosci 18:624–627CrossRefPubMed
71.
Acosta FL, Cloyd JM, Aryan HE, Ames CP (2009) Perioperative complications and clinical outcomes of multilevel circumferential lumbar spinal fusion in the elderly. J Clin Neurosci 16:69–73CrossRefPubMed
72.
Hrabalek L, Adamus M, Gryga A, Wanek T, Tucek P (2014) A comparison of complication rate between anterior and lateral approaches to the lumbar spine. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 158:127–132PubMed
73.
Quraishi NA, Konig M, Booker SJ et al (2013) Access related complications in anterior lumbar surgery performed by spinal surgeons. Eur Spine J 22(Suppl 1):S16–S20CrossRefPubMed
74.
Phillips FM, Isaacs RE, Rodgers WB et al (2013) Adult degenerative scoliosis treated with XLIF: clinical and radiographical results of a prospective multicenter study with 24-month follow-up. Spine 38:1853–1861CrossRefPubMed
75.
Rodgers WB, Cox CS, Gerber EJ (2010) Early complications of extreme lateral interbody fusion in the obese. J Spinal Disord Tech 23:393–397CrossRefPubMed
76.
Lucio JC, Vanconia RB, Deluzio KJ, Lehmen JA, Rodgers JA, Rodgers W (2012) Economics of less invasive spinal surgery: an analysis of hospital cost differences between open and minimally invasive instrumented spinal fusion procedures during the perioperative period. Risk Manag Healthc Policy 5:65–74PubMedCentralPubMed
77.
Smith WD, Christian G, Serrano S, Malone KT (2012) A comparison of perioperative charges and outcome between open and mini-open approaches for anterior lumbar discectomy and fusion. J Clin Neurosci 19:673–680CrossRefPubMed
78.
Rodgers WB, Gerber EJ, Rodgers JA (2010) Lumbar fusion in octogenarians: the promise of minimally invasive surgery. Spine 35:S355–S360CrossRefPubMed
79.
Rea LM, Parker RA (2012) Designing and conducting survey research: a comprehensive guide, Wiley
80.
Ahmadian A, Deukmedjian AR, Abel N, Dakwar E, Uribe JS (2013) Analysis of lumbar plexopathies and nerve injury after lateral retroperitoneal transpsoas approach: diagnostic standardization. J Neurosurg Spine 18:289–297CrossRefPubMed
Metadata
Title
Visceral, vascular, and wound complications following over 13,000 lateral interbody fusions: a survey study and literature review
Authors
Juan S. Uribe
Armen R. Deukmedjian
Publication date
01-04-2015
Publisher
Springer Berlin Heidelberg
Published in
European Spine Journal / Issue Special Issue 3/2015
Print ISSN: 0940-6719
Electronic ISSN: 1432-0932
DOI
https://doi.org/10.1007/s00586-015-3806-4

Other articles of this Special Issue 3/2015

European Spine Journal 3/2015 Go to the issue

Original Article

Substantial clinical benefit of minimally invasive lateral interbody fusion for degenerative spondylolisthesis

Original Article

Anterior column realignment from a lateral approach for the treatment of severe sagittal imbalance: a retrospective radiographic study

Case Report

A case report of a rare complication of bowel perforation in extreme lateral interbody fusion

Original Article

Impaired bone mineral density as a predictor of graft subsidence following minimally invasive transpsoas lateral lumbar interbody fusion

Review Article

MIS lateral spine surgery: a systematic literature review of complications, outcomes, and economics

Original Article

Radiographic outcomes of anterior column realignment for adult sagittal plane deformity: a multicenter analysis