Abstract
Introduction
Retrospective analysis of intra- and postoperative complications in a consecutive series of 144 patients operated for lumbar extreme lateral interbody fusion (XLIF).
Patients and Methods
A total of 144 patients, with a minimum follow-up of 6 months, affected with degenerative spinal conditions of the lumbar spine, were treated with XLIF with and without posterior instrumentation. Data were collected by retrospective analysis of hospital files and confidential computer-held database. Documented complication types and rates of this series were compared with previous reports on lateral approach fusions.
Results
A total 179 levels were treated of whom 61% at one level, 30% at two levels, 6% at three levels, and 3% at four levels. Overall, 55% included level L4–L5. A total of 82.7% included supplemental internal fixation with 96% including bilateral pedicle screw fixation. A total of 27 (25.6%) events occurred in 22 (21.1%) patients. There were 9 (8.6%) permanent complications lasting longer than 6 months and 18 (17.3%) temporary complications that resolved inside the 6 months post-op period. Overall, 10 (9.6%) complications were judged severe: three cases of permanent nerve root lesion, two surgically treated adjacent level syndromes, one surgically treated subsidence, one deep infection, one vascular lesion, and one post-op pancreatitis. Overall, 17 (16.3%) were judged nonsever complications and solved during the 6-month follow-up. Overall, 24 events were XLIF related whereas 3 were not related to XLIF (one pancreatitis and two infection of posterior instrumentation).
Conclusion
Compared with open anterior interbody fusion approaches, the extreme lateral approach with XLIF technique resulted in a lower incidence of infection, visceral and neurologic injury. Some specific approach-related mild and temporary events such as nerve-root irritation could be regarded more like a approach comorbidity rather than a real complication.