Perioperative complications in patients undergoing open transforaminal lumbar interbody fusion as a revision surgery

Clinical article

Imad Saeed Khan M.D. 1 , Ashish Sonig M.D., M.S., M.Ch. 2 , Jai Deep Thakur M.D. 3 , Papireddy Bollam M.D. 2 and Anil Nanda M.D., M.P.H. 2
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  • 1 Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, Tennessee;
  • 2 Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, Louisiana; and
  • 3 Department of Surgery, New York Medical College, Valhalla, New York
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Object

Transforaminal lumbar interbody fusion (TLIF) has been increasingly used to treat degenerative spine disease, including that in patients in whom earlier decompressive procedures have failed. Reexploration in these cases is always challenging and is thought to pose a higher risk of complications. To the best of the authors' knowledge, there are no current studies specifically analyzing the effects of previous lumbar decompressive surgeries on the complication rates of open TLIF.

Methods

The authors performed a retrospective study of surgeries performed by a single surgeon. A total of 187 consecutive patients, in whom the senior author (A.N.) had performed open TLIF between January 2007 and January 2011, met the inclusion criteria. The patients were divided into two groups (primary and revision TLIF) for the comparison of perioperative complications.

Results

Overall, the average age of the patients was 49.7 years (range 18–80 years). Of the 187 patients, 73 patients had no history of lumbar surgery and 114 were undergoing revision surgery. Fifty-four patients (28.9%) had a documented complication intraoperatively or postoperatively. There was no difference in the rate on perioperative complications between the two groups (overall, medical, wound related, inadvertent dural tears [DTs], or neural injury). Patients who had undergone more than one previous lumbar surgery were, however, more likely to have suffered from DTs (p = 0.054) and neural injuries (p = 0.007) compared with the rest.

Conclusions

In the hands of an experienced surgeon, revision open TLIF does not necessarily increase the risk of perioperative complications compared with primary TLIF. Two or more previous lumbar decompressive procedures, however, increase the risk of inadvertent DTs and neural injury.

Abbreviations used in this paper:BMP = bone morphogenetic protein; DDD = degenerative disc disease; DT = dural tear; TLIF = transforaminal lumbar interbody fusion.

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Contributor Notes

Address correspondence to: Anil Nanda, M.D., Department of Neurosurgery, Louisiana State University Health Sciences Center, 1501 Kings Highway, Shreveport, Louisiana 71130. email: ananda@lsuhsc.edu.

Please include this information when citing this paper: published online December 21, 2012; DOI: 10.3171/2012.11.SPINE12558.

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