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

Clinical article

Restricted access

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.

Article Information

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.

© AANS, except where prohibited by US copyright law.

Headings

Figures

  • View in gallery

    Histogram showing the distribution of inadvertent DTs according to the number of previous lumbar decompressive procedures.

References

1

Adogwa OParker SLBydon ACheng JMcGirt MJ: Comparative effectiveness of minimally invasive versus open transforaminal lumbar interbody fusion: 2-year assessment of narcotic use, return to work, disability, and quality of life. J Spinal Disord Tech 24:4794842011

2

Djurasovic MGlassman SDHoward JMCopay AGCarreon LY: Health-related quality of life improvements in patients undergoing lumbar spinal fusion as a revision surgery. Spine (Phila Pa 1976) 36:2692762011

3

Glassman SGornet MFBranch CPolly D JrPeloza JSchwender JD: MOS short form 36 and Oswestry Disability Index outcomes in lumbar fusion: a multicenter experience. Spine J 6:21262006

4

Glassman SDMinkow REDimar JRPuno RMRaque GHJohnson JR: Effect of prior lumbar discectomy on outcome of lumbar fusion: a prospective analysis using the SF-36 measure. J Spinal Disord 11:3833881998

5

Harms JGJeszenszky D: [The unilateral, transforaminal approach for posterior lumbar interbody fusion.]. Oper Orthop Traumatol 10:901021998. (Ger)

6

Lee JCJang HDShin BJ: Learning curve and clinical outcomes of minimally invasive transforaminal lumbar interbody fusion: our experience in 86 consecutive cases. Spine (Phila Pa 1976) 37:154815572012

7

Lee PFessler RG: Perioperative and postoperative complications of single-level minimally invasive transforaminal lumbar interbody fusion in elderly adults. J Clin Neurosci 19:1111142012

8

Lowe TGTahernia ADO'Brien MFSmith DAB: Unilateral transforaminal posterior lumbar interbody fusion (TLIF): indications, technique, and 2-year results. J Spinal Disord Tech 15:31382002

9

Owens KGlassman SDHoward JMDjurasovic MWitten JLCarreon LY: Perioperative complications with rhBMP-2 in transforaminal lumbar interbody fusion. Eur Spine J 20:6126172011

10

Potter BKFreedman BAVerwiebe EGHall JMPolly DW JrKuklo TR: Transforaminal lumbar interbody fusion: clinical and radiographic results and complications in 100 consecutive patients. J Spinal Disord Tech 18:3373462005

11

Rodgers WBGerber EJPatterson J: Intraoperative and early postoperative complications in extreme lateral interbody fusion: an analysis of 600 cases. Spine (Phila Pa 1976) 36:26322011

12

Salehi SATawk RGanju ALaMarca FLiu JCOndra SL: Transforaminal lumbar interbody fusion: surgical technique and results in 24 patients. Neurosurgery 54:3683742004

13

Schwender JDHolly LTRouben DPFoley KT: Minimally invasive transforaminal lumbar interbody fusion (TLIF): technical feasibility and initial results. J Spinal Disord Tech 18:SupplS1S62005

14

Selznick LAShamji MFIsaacs RE: Minimally invasive interbody fusion for revision lumbar surgery: technical feasibility and safety. J Spinal Disord Tech 22:2072132009

15

Tormenti MJMaserati MBBonfield CMGerszten PCMoossy JJKanter AS: Perioperative surgical complications of transforaminal lumbar interbody fusion: a single-center experience. Clinical article. J Neurosurg Spine 16:44502012

16

Wang JZhou YZhang ZFLi CQZheng WJLiu J: Minimally invasive or open transforaminal lumbar interbody fusion as revision surgery for patients previously treated by open discectomy and decompression of the lumbar spine. Eur Spine J 20:6236282011

TrendMD

Metrics

Metrics

All Time Past Year Past 30 Days
Abstract Views 42 42 4
Full Text Views 100 100 9
PDF Downloads 95 95 10
EPUB Downloads 0 0 0

PubMed

Google Scholar