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lateral_lumbar_interbody_fusion_complications

Lateral lumbar interbody fusion complications

Reported complication rates for minimally invasive lateral transpsoas interbody fusion (MIS-LIF) vary widely.

The complication rate during the LLIF procedure has been reported to range from 2% to 30% with up to 20% minor and 8.6% major complications 1) 2) 3).

Skin abrasion

One type of minor complication that can be experienced is related to skin abrasion from tape as the patient is secured to the bed. Surgeons typically tape bony prominences by applying foam pads on the skin but not over truncal regions. Since the patient is asleep for the taping procedure, there is no knowledge about how much pressure applied to the skin can cause pain.

Pain

A second minor complication is the incidence of pain mimicking that of trochanteric bursitis presumably due to direct pressure of the greater trochanter against the table.

Rhabdomyolysis

A major complication with LLIF is rhabdomyolysis or muscle necrosis due to prolonged soft tissue pressure which can lead to acute renal failure 4). Rhabodmyolsis can be diagnosed by rising creatine phosphokinase levels and must be quickly identified to initiate appropriate medical treatment.

Subsidence

Intervertebral cage settling during bone remodeling after lumbar lateral interbody fusion (LIF) is a common occurrence during the normal healing process.

Malham et al. distinguished between early cage subsidence (ECS) and and delayed cage subsidence (DCS). Radiographic subsidence (DCS) was categorized using descriptors for the location and severity of the subsidence. Neither interbody fusion rates nor clinical outcomes were affected by radiographic subsidence. To protect patients from subsidence after MIS LIF, the surgeon needs to take care with the caudal endplate during cage insertion. If a caudal bilateral (Type 2) endplate breach is detected, supplemental posterior fixation to arrest progression and facilitate fusion is recommended 5).

Neurologic Injury

References

1)
Youssef JA, McAfee PC, Patty CA, et al. Minimally invasive surgery: lateral approach interbody fusion: results and review. Spine. 2010;35:S302.
2)
Rodgers WB, Gerber EJ, Patterson J. Intraoperative and early postoperative complications in extreme lateral interbody fusion: an analysis of 600 cases. Spine. 2011;1(36):26–32.
3)
Smith WD, Christian GM, Serrano S. Neurologic complications in extreme lateral interbody fusion (XLIF): A comparative analysis of levels L2-3, L3-4, and L4-5. The Spine Journal. 2012;12(9):S124.
4)
Dakwar E, Rifkin SI, Volcan IJ, et al. Rhabdomyolysis and acute renal failure following minimally invasive spine surgery. J Neurosurg Spine. 2011;14:785–788.
5)
Malham GM, Parker RM, Blecher CM, Seex KA. Assessment and classification of subsidence after lateral interbody fusion using serial computed tomography. J Neurosurg Spine. 2015 Jul 24:1-9. [Epub ahead of print] PubMed PMID: 26207320.
lateral_lumbar_interbody_fusion_complications.txt · Last modified: 2019/01/10 16:23 by administrador