Perioperative complications of minimally invasive transforaminal lumbar interbody fusion

English Keywords:Lumbar degenerative diseases  Minimally invasive surgery  Transforaminal lumbar interbody fusion  Complications

English Abstract:

  【Abstract】 Objectives: To analyze the perioperative complications relative to minimally invasive transforaminal lumbar interbody fusion(MIS-TLIF) for degenerative lumbar diseases, and to explore the prophylactic and therapeutic measures. Methods: The clinical data of 523 MIS-TLIF surgeries on degenerative lumbar diseases, performed between June 2007 and July 2013, were collected in a retrospective study. The study group comprised 523 patients with a mean age of 53.1±8.4 years(range, 31-83 years), which included 231 males and 292 females. The degenerative lumbar diseases included lumbar spondylolisthesis in 194 cases, lumbar stenosis in 128 cases, lumbar instability in 62 cases, massive lumbar disc herniation in 59 cases, recurrent lumbar diseases in 52 cases including 26 cases after open lumbar discectomy, 17 cases after microendoscopic discectomy and 9 cases after percutaneous endoscopic lumbar discectomy, and degenerative disc disease(DDD) in 28 cases. Perioperative complications were defined as those occurred within 1 month postoperatively. Persistent complications were defined as a new deficit extending more than 30 days without improvement after the surgery. Transient complications were defined as a new deficit resulting from the procedure, which improved within 30 days of the surgical intervention. The incidence and cause of complications were analyzed, and the prophylactic and therapeutic measures were discussed. Results: The average follow-up period was 47.5±8.2 months(range, 24-81 months). Amomg 96 perioperative complications observed in 523 patients, 2 persistent complications including one direct injury to nerve root caused by hardware malposition as a result of pedicle anatomic deformity and one direct injury to exiting nerve root caused by manipulative error which led to persistent nerve dysfunction, and 94 transient complications occurred. Among 94 transient complications, leg numbness was the most common complication with an incidence rate of 10.71%(56/523). Dural tears occurred in 21 cases, superficial wound infection in 9 cases, and deep wound infection in 1 case. Only one complication occurred in 88 patients. Four patients had two complications. The incidence of perioperative complications was 17.59%(92/523 patients) in this series. The complication rate in different degenerative lumbar diseases was 17.53% in spondylolisthesis, 17.19% in lumbar stenosis, 14.52% in lumbar instability, 13.56% in massive lumbar disc herniation， 30.77% in revision surgery， 10.71% in degenerative disc diseases. There was no significant difference with respect to the incidence rate between one-level MIS-TLIF(17.53%) and two-level MIS-TLIF(18.42%)（χ2=0.02，P＞0.05）. Conclusions: MIS-TLIF is an effective technique for lumbar degenerative diseases. Perioperative complications include injuries to nerve roots, dural tear, wound infection and leg numbness. Transient leg numbness is the most common complication in this series.