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

Restricted access

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.
Article Information

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.

© AANS, except where prohibited by US copyright law.

Headings
References
  • 1

    Aota YKumano KHirabayashi S: Postfusion instability at the adjacent segments after rigid pedicle screw fixation for degenerative lumbar spinal disorders. J Spinal Disord 8:4644731995

    • Search Google Scholar
    • Export Citation
  • 2

    Axelsson PJohnsson RStromqvist BArvidsson MHerrlin K: Posterolateral lumbar fusion. Outcome of 71 consecutive operations after 4 (2–7) years. Acta Orthop Scand 65:3093141994

    • Search Google Scholar
    • Export Citation
  • 3

    Booth KCBridwell KHEisenberg BABaldus CRLenke LG: Minimum 5-year results of degenerative spondylolisthesis treated with decompression and instrumented posterior fusion. Spine 24:172117271999

    • Search Google Scholar
    • Export Citation
  • 4

    Carreon LYPuno RMDimar JR IIGlassman SDJohnson JR: Perioperative complications of posterior lumbar decompression and arthrodesis in older adults. J Bone Joint Surg Am 85:208920922003

    • Search Google Scholar
    • Export Citation
  • 5

    Chen WJNiu CCChen LHShih CH: Survivorship analysis of DKS instrumentation in the treatment of spondylolisthesis. Clin Orthop Relat Res 339:1131201997

    • Search Google Scholar
    • Export Citation
  • 6

    Davne SHMyers DL: Complications of lumbar spinal fusion with transpedicular instrumentation. Spine 17:S184S1891992

  • 7

    Deyo RACiol MACherkin DCLoeser JDBigos SJ: Lumbar spinal fusion. A cohort study of complications, reoperations, and resource use in the Medicare population. Spine 18:146314701993

    • Search Google Scholar
    • Export Citation
  • 8

    Elias WJSimmons NEKaptain GJChadduck JBWhitehill R: Complications of posterior lumbar interbody fusion when using a titanium threaded cage device. J Neurosurg 93 :1 Suppl45522000

    • Search Google Scholar
    • Export Citation
  • 9

    Enker PSteffee AD: Interbody fusion and instrumentation. Clin Orthop Relat Res 300:901011994

  • 10

    Esses SISachs BLDreyzin V: Complications associated with the technique of pedicle screw fixation. A selected survey of ABS members. Spine 18:223122381993

    • Search Google Scholar
    • Export Citation
  • 11

    Etebar SCahill DW: Risk factors for adjacent-segment failure following lumbar fixation with rigid instrumentation for degenerative instability. J Neurosurg 90 :2 Suppl1631691999

    • Search Google Scholar
    • Export Citation
  • 12

    Freeman BJLicina PMehdian SH: Posterior lumbar interbody fusion combined with instrumented postero-lateral fusion: 5-year results in 60 patients. Eur Spine J 9:42462000

    • 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 82:145814762000

    • Search Google Scholar
    • Export Citation
  • 14

    Glassman SDAlegre GCarreon LDimar JRJohnson JR: Perioperative complications of lumbar instrumentation and fusion in patients with diabetes mellitus. Spine J 3:4965012003

    • Search Google Scholar
    • Export Citation
  • 15

    Hambly MFWiltse LLRaghavan NSchneiderman GKoenig C: The transition zone above a lumbosacral fusion. Spine 23:178517921998

  • 16

    Jutte PCCastelein RM: Complications of pedicle screws in lumbar and lumbosacral fusions in 105 consecutive primary operations. Eur Spine J 11:5945982002

    • Search Google Scholar
    • Export Citation
  • 17

    Kai YOyama MMorooka M: Posterior lumbar interbody fusion using local facet joint autograft and pedicle screw fixation. Spine 29:41462004

    • Search Google Scholar
    • Export Citation
  • 18

    Kanayama MHashimoto TShigenobu KHarada MOha FOhkoshi Y: Adjacent-segment morbidity after Graf ligamentoplasty compared with posterolateral lumbar fusion. J Neurosurg 95 :1 Suppl5102001

    • Search Google Scholar
    • Export Citation
  • 19

    Kumar MNBaklanov AChopin D: Correlation between sagittal plane changes and adjacent segment degeneration following lumbar spine fusion. Eur Spine J 10:3143192001

    • Search Google Scholar
    • Export Citation
  • 20

    Kuslich SDDanielson GDowdle JDSherman JFredrickson BYuan H: Four-year follow-up results of lumbar spine arthrodesis using the Bagby and Kuslich lumbar fusion cage. Spine 25:265626622000

    • Search Google Scholar
    • Export Citation
  • 21

    Miyakoshi NAbe EShimada YOkuyama KSuzuki TSato K: Outcome of one-level posterior lumbar interbody fusion for spondylolisthesis and postoperative intervertebral disc degeneration adjacent to the fusion. Spine 25:183718422000

    • Search Google Scholar
    • Export Citation
  • 22

    Nakai SYoshizawa HKobayashi S: Long-term follow-up study of posterior lumbar interbody fusion. J Spinal Disord 12:2932991999

  • 23

    Okuda SIwasaki MMiyauchi AAono HMorita MYamamoto T: Risk factors for adjacent segment degeneration after PLIF. Spine 29:153515402004

    • Search Google Scholar
    • Export Citation
  • 24

    Okuyama KAbe ESuzuki TTamura YChiba MSato K: Posterior lumbar interbody fusion: a retrospective study of complications after facet joint excision and pedicle screw fixation in 148 cases. Acta Orthop Scand 70:3293341999

    • Search Google Scholar
    • Export Citation
  • 25

    Park PGarton HJGala VCHoff JTMcGillicuddy JE: Adjacent segment disease after lumbar or lumbosacral fusion: review of the literature. Spine 29:193819442004

    • Search Google Scholar
    • Export Citation
  • 26

    Pihlajamaki HBostman ORuuskanen MMyllynen PKinnunen JKaraharju E: Posterolateral lumbosacral fusion with transpedicular fixation: 63 consecutive cases followed for 4 (2–6) years. Acta Orthop Scand 67:63681996

    • Search Google Scholar
    • Export Citation
  • 27

    Rahm MDHall BB: Adjacent-segment degeneration after lumbar fusion with instrumentation: a retrospective study. J Spinal Disord 9:3924001996

    • Search Google Scholar
    • Export Citation
  • 28

    Rivet DJJeck DBrennan JEpstein ALauryssen C: Clinical outcomes and complications associated with pedicle screw fixation-augmented lumbar interbody fusion. J Neurosurg Spine 1:2612662004

    • Search Google Scholar
    • Export Citation
  • 29

    Scaduto AAGamradt SCYu WDHuang JDelamarter RBWang JC: Perioperative complications of threaded cylindrical lumbar interbody fusion devices: anterior versus posterior approach. J Spinal Disord Tech 16:5025072003

    • Search Google Scholar
    • Export Citation
  • 30

    Seitsalo SSchlenzka DPoussa MOsterman K: Disc degeneration in young patients with isthmic spondylolisthesis treated operatively or conservatively: a long-term follow-up. Eur Spine J 6:3933971997

    • Search Google Scholar
    • Export Citation
  • 31

    Stonecipher TWright S: Posterior lumbar interbody fusion with facet-screw fixation. Spine 14:4684711989

  • 32

    Wetzel FTLaRocca H: The failed posterior lumbar interbody fusion. Spine 16:8398451991

  • 33

    Yamamoto TOhkohchi TOhwada TKotoku HHarada N: Clinical and radiological results of PLIF for degenerative spondylolisthesis. J Mus Res 2:1811951998

    • Search Google Scholar
    • Export Citation
TrendMD
Cited By
Metrics

Metrics

All Time Past Year Past 30 Days
Abstract Views 552 548 101
Full Text Views 202 167 7
PDF Downloads 158 125 10
EPUB Downloads 0 0 0
PubMed
Google Scholar