Surgical complications of posterior lumbar interbody fusion with total facetectomy in 251 patients

Shinya Okuda Department of Orthopaedic Surgery, Osaka Rosai Hospital, Osaka; and Department of Orthopaedic Surgery, Hyogo, Japan

Search for other papers by Shinya Okuda in
jns
Google Scholar
PubMed Close
 M.D.
,
Akira Miyauchi Department of Orthopaedic Surgery, Osaka Rosai Hospital, Osaka; and Department of Orthopaedic Surgery, Hyogo, Japan

Search for other papers by Akira Miyauchi in
jns
Google Scholar
PubMed Close
 M.D.
,
Takenori Oda Department of Orthopaedic Surgery, Osaka Rosai Hospital, Osaka; and Department of Orthopaedic Surgery, Hyogo, Japan

Search for other papers by Takenori Oda in
jns
Google Scholar
PubMed Close
 M.D.
,
Takamitsu Haku Department of Orthopaedic Surgery, Osaka Rosai Hospital, Osaka; and Department of Orthopaedic Surgery, Hyogo, Japan

Search for other papers by Takamitsu Haku in
jns
Google Scholar
PubMed Close
 M.D.
,
Tomio Yamamoto Department of Orthopaedic Surgery, Osaka Rosai Hospital, Osaka; and Department of Orthopaedic Surgery, Hyogo, Japan

Search for other papers by Tomio Yamamoto in
jns
Google Scholar
PubMed Close
 M.D.
, and
Motoki Iwasaki Department of Orthopaedic Surgery, Osaka Rosai Hospital, Osaka; and Department of Orthopaedic Surgery, Hyogo, Japan

Search for other papers by Motoki Iwasaki in
jns
Google Scholar
PubMed Close
 M.D.
Page Range:
304–309
Volume/Issue:
Volume 4: Issue 4
DOI link:
https://doi.org/10.3171/spi.2006.4.4.304
Restricted access

Purchase Now

USD  $45.00

Spine - 1 year subscription bundle (Individuals Only)

USD  $384.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $624.00
Click here for subscription options

  • Purchase Now

    USD  $45.00

  • Spine - 1 year subscription bundle (Individuals Only)

    USD  $384.00

  • JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

    USD  $624.00
USD  $45.00
USD  $384.00
USD  $624.00
Print or Print + Online Sign in

Object

Previous studies of surgical complications associated with posterior lumbar interbody fusion (PLIF) are of limited value due to intrastudy variation in instrumentation and fusion techniques. The purpose of the present study was to examine rates of intraoperative and postoperative complications of PLIF using a large number of cases with uniform instrumentation and a uniform fusion technique.

Methods

The authors reviewed the hospital records of 251 patients who underwent PLIF for degenerative lumbar disorders between 1996 and 2002 and who could be followed for at least 2 years. Intraoperative, early postoperative, and late postoperative complications were investigated.

Intraoperative complications occurred in 26 patients: dural tearing in 19 patients and pedicle screw malposition in seven patients. Intraoperative complications did not affect the postoperative clinical results. Early postoperative complications occurred in 19 patients: brain infarction occurred in one, infection in one, and neurological complications in 17. Of the 17 patients with neurological complications, nine showed severe motor loss such as foot drop; the remaining eight patients showed slight motor loss or radicular pain alone, and their symptoms improved within 6 weeks. Late postoperative complications occurred in 17 patients: hardware failure in three, nonunion in three, and adjacent-segment degeneration in 11. Postoperative progression of symptomatic adjacentsegment degeneration was defined as a condition that required additional surgery to treat neurological deterioration.

Conclusions

The most serious complications of PLIF were postoperative severe neurological deficits and adjacent-segment degeneration. Prevention and management of such complications are necessary to attain good long-term clinical results.

Abbreviations used in this paper:

CT = computerized tomography; JOA = Japanese Orthopaedic Association; MMT = manual muscle test; PLIF = posterior lumbar interbody fusion.
  • Collapse
  • Expand

Contributor Notes

Address reprint requests to: Shinya Okuda, M.D., Department of Orthopaedic Surgery, Osaka Rosai Hospital, 1179-3 Nagasone-cho, Sakai, Osaka, 591-8025, Japan. email: okuda@orh.go.jp.
Keywords:
lumbar spine; spinal fusion; facetectomy; complication
Page Count:
6
  • 1

    Aota Y, , Kumano K, & Hirabayashi S: Postfusion instability at the adjacent segments after rigid pedicle screw fixation for degenerative lumbar spinal disorders. J Spinal Disord 8:464–473, 1995

    • Search Google Scholar
    • Export Citation
  • 2

    Axelsson P, , Johnsson R, , Stromqvist B, , Arvidsson M, & Herrlin K: Posterolateral lumbar fusion. Outcome of 71 consecutive operations after 4 (2–7) years. Acta Orthop Scand 65:309–314, 1994

    • Search Google Scholar
    • Export Citation
  • 3

    Booth KC, , Bridwell KH, , Eisenberg BA, , Baldus CR, & Lenke LG: Minimum 5-year results of degenerative spondylolisthesis treated with decompression and instrumented posterior fusion. Spine 24:1721–1727, 1999

    • Search Google Scholar
    • Export Citation
  • 4

    Carreon LY, , Puno RM, , Dimar JR II, , Glassman SD, & Johnson JR: Perioperative complications of posterior lumbar decompression and arthrodesis in older adults. J Bone Joint Surg Am 85:2089–2092, 2003

    • Search Google Scholar
    • Export Citation
  • 5

    Chen WJ, , Niu CC, , Chen LH, & Shih CH: Survivorship analysis of DKS instrumentation in the treatment of spondylolisthesis. Clin Orthop Relat Res 339:113–120, 1997

    • Search Google Scholar
    • Export Citation
  • 6

    Davne SH, & Myers DL: Complications of lumbar spinal fusion with transpedicular instrumentation. Spine 17:S184–S189, 1992

  • 7

    Deyo RA, , Ciol MA, , Cherkin DC, , Loeser JD, & Bigos SJ: Lumbar spinal fusion. A cohort study of complications, reoperations, and resource use in the Medicare population. Spine 18:1463–1470, 1993

    • Search Google Scholar
    • Export Citation
  • 8

    Elias WJ, , Simmons NE, , Kaptain GJ, , Chadduck JB, & Whitehill R: Complications of posterior lumbar interbody fusion when using a titanium threaded cage device. J Neurosurg 93 :1 Suppl 45–52, 2000

    • Search Google Scholar
    • Export Citation
  • 9

    Enker P, & Steffee AD: Interbody fusion and instrumentation. Clin Orthop Relat Res 300:90–101, 1994

  • 10

    Esses SI, , Sachs BL, & Dreyzin V: Complications associated with the technique of pedicle screw fixation. A selected survey of ABS members. Spine 18:2231–2238, 1993

    • Search Google Scholar
    • Export Citation
  • 11

    Etebar S, & Cahill DW: Risk factors for adjacent-segment failure following lumbar fixation with rigid instrumentation for degenerative instability. J Neurosurg 90 :2 Suppl 163–169, 1999

    • Search Google Scholar
    • Export Citation
  • 12

    Freeman BJ, , Licina P, & Mehdian SH: Posterior lumbar interbody fusion combined with instrumented postero-lateral fusion: 5-year results in 60 patients. Eur Spine J 9:42–46, 2000

    • Search Google Scholar
    • Export Citation
  • 13

    Gaines RW Jr: The use of pedicle-screw internal fixation for the operative treatment of spinal disorders. J Bone Joint Surg Am 82:1458–1476, 2000

    • Search Google Scholar
    • Export Citation
  • 14

    Glassman SD, , Alegre G, , Carreon L, , Dimar JR, & Johnson JR: Perioperative complications of lumbar instrumentation and fusion in patients with diabetes mellitus. Spine J 3:496–501, 2003

    • Search Google Scholar
    • Export Citation
  • 15

    Hambly MF, , Wiltse LL, , Raghavan N, , Schneiderman G, & Koenig C: The transition zone above a lumbosacral fusion. Spine 23:1785–1792, 1998

  • 16

    Jutte PC, & Castelein RM: Complications of pedicle screws in lumbar and lumbosacral fusions in 105 consecutive primary operations. Eur Spine J 11:594–598, 2002

    • Search Google Scholar
    • Export Citation
  • 17

    Kai Y, , Oyama M, & Morooka M: Posterior lumbar interbody fusion using local facet joint autograft and pedicle screw fixation. Spine 29:41–46, 2004

    • Search Google Scholar
    • Export Citation
  • 18

    Kanayama M, , Hashimoto T, , Shigenobu K, , Harada M, , Oha F, & Ohkoshi Y, et al.: Adjacent-segment morbidity after Graf ligamentoplasty compared with posterolateral lumbar fusion. J Neurosurg 95 :1 Suppl 5–10, 2001

    • Search Google Scholar
    • Export Citation
  • 19

    Kumar MN, , Baklanov A, & Chopin D: Correlation between sagittal plane changes and adjacent segment degeneration following lumbar spine fusion. Eur Spine J 10:314–319, 2001

    • Search Google Scholar
    • Export Citation
  • 20

    Kuslich SD, , Danielson G, , Dowdle JD, , Sherman J, , Fredrickson B, & Yuan H, et al.: Four-year follow-up results of lumbar spine arthrodesis using the Bagby and Kuslich lumbar fusion cage. Spine 25:2656–2662, 2000

    • Search Google Scholar
    • Export Citation
  • 21

    Miyakoshi N, , Abe E, , Shimada Y, , Okuyama K, , Suzuki T, & Sato K: Outcome of one-level posterior lumbar interbody fusion for spondylolisthesis and postoperative intervertebral disc degeneration adjacent to the fusion. Spine 25:1837–1842, 2000

    • Search Google Scholar
    • Export Citation
  • 22

    Nakai S, , Yoshizawa H, & Kobayashi S: Long-term follow-up study of posterior lumbar interbody fusion. J Spinal Disord 12:293–299, 1999

  • 23

    Okuda S, , Iwasaki M, , Miyauchi A, , Aono H, , Morita M, & Yamamoto T: Risk factors for adjacent segment degeneration after PLIF. Spine 29:1535–1540, 2004

    • Search Google Scholar
    • Export Citation
  • 24

    Okuyama K, , Abe E, , Suzuki T, , Tamura Y, , Chiba M, & Sato K: Posterior lumbar interbody fusion: a retrospective study of complications after facet joint excision and pedicle screw fixation in 148 cases. Acta Orthop Scand 70:329–334, 1999

    • Search Google Scholar
    • Export Citation
  • 25

    Park P, , Garton HJ, , Gala VC, , Hoff JT, & McGillicuddy JE: Adjacent segment disease after lumbar or lumbosacral fusion: review of the literature. Spine 29:1938–1944, 2004

    • Search Google Scholar
    • Export Citation
  • 26

    Pihlajamaki H, , Bostman O, , Ruuskanen M, , Myllynen P, , Kinnunen J, & Karaharju E: Posterolateral lumbosacral fusion with transpedicular fixation: 63 consecutive cases followed for 4 (2–6) years. Acta Orthop Scand 67:63–68, 1996

    • Search Google Scholar
    • Export Citation
  • 27

    Rahm MD, & Hall BB: Adjacent-segment degeneration after lumbar fusion with instrumentation: a retrospective study. J Spinal Disord 9:392–400, 1996

    • Search Google Scholar
    • Export Citation
  • 28

    Rivet DJ, , Jeck D, , Brennan J, , Epstein A, & Lauryssen C: Clinical outcomes and complications associated with pedicle screw fixation-augmented lumbar interbody fusion. J Neurosurg Spine 1:261–266, 2004

    • Search Google Scholar
    • Export Citation
  • 29

    Scaduto AA, , Gamradt SC, , Yu WD, , Huang J, , Delamarter RB, & Wang JC: Perioperative complications of threaded cylindrical lumbar interbody fusion devices: anterior versus posterior approach. J Spinal Disord Tech 16:502–507, 2003

    • Search Google Scholar
    • Export Citation
  • 30

    Seitsalo S, , Schlenzka D, , Poussa M, & Osterman K: Disc degeneration in young patients with isthmic spondylolisthesis treated operatively or conservatively: a long-term follow-up. Eur Spine J 6:393–397, 1997

    • Search Google Scholar
    • Export Citation
  • 31

    Stonecipher T, & Wright S: Posterior lumbar interbody fusion with facet-screw fixation. Spine 14:468–471, 1989

  • 32

    Wetzel FT, & LaRocca H: The failed posterior lumbar interbody fusion. Spine 16:839–845, 1991

  • 33

    Yamamoto T, , Ohkohchi T, , Ohwada T, , Kotoku H, & Harada N: Clinical and radiological results of PLIF for degenerative spondylolisthesis. J Mus Res 2:181–195, 1998

    • Search Google Scholar
    • Export Citation

Metrics

All Time Past Year Past 30 Days
Abstract Views 2747 375 25
Full Text Views 363 37 3
PDF Downloads 309 53 5
EPUB Downloads 0 0 0