Clin Orthop Surg.  2015 Mar;7(1):91-96. 10.4055/cios.2015.7.1.91.

Perioperative Surgical Complications and Learning Curve Associated with Minimally Invasive Transforaminal Lumbar Interbody Fusion: A Single-Institute Experience

• Park Y
• Lee SB
• Seok SO
• Jo BW
• Ha JW

• KMID: 2069880
• DOI: http://doi.org/10.4055/cios.2015.7.1.91

Abstract

BACKGROUND
As surgical complications tend to occur more frequently in the beginning stages of a surgeon's career, knowledge of perioperative complications is important to perform a safe procedure, especially if the surgeon is a novice. We sought to identify and describe perioperative complications and their management in connection with minimally invasive transforaminal lumbar interbody fusion (TLIF).
METHODS
We performed a retrospective chart review of our first 124 patients who underwent minimally invasive TLIF. The primary outcome measure was adverse events during the perioperative period, including neurovascular injury, implant-related complications, and wound infection. Pseudarthroses and adjacent segment pathologies were not included in this review. Adverse events that were not specifically related to spinal surgery and did not affect recovery were also excluded.
RESULTS
Perioperative complications occurred in 9% of patients (11/124); including three cases of temporary postoperative neuralgia, two deep wound infections, two pedicle screw misplacements, two cage migrations, one dural tear, and one grafted bone extrusion. No neurologic deficits were reported. Eight complications occurred in the first one-third of the series and only 3 complications occurred in the last two-thirds of the series. Additional surgeries were performed in 6% of patients (7/124); including four reoperations (two for cage migrations, one for a misplaced screw, and one for an extruded graft bone fragment) and three hardware removals (one for a misplaced screw and two for infected cages).
CONCLUSIONS
We found perioperative complications occurred more often in the early period of a surgeon's experience with minimally invasive TLIF. Implant-related complications were common and successfully managed by additional surgeries in this series. We suggest greater caution should be exercised to avoid the potential complications, especially when surgeon is a novice to this procedure.

Keyword

Complications; Learning curve; Minimally invasive; Spine fusion; Lumbar vertebrae

MeSH Terms

Adult
Aged
Aged, 80 and over
Female
Humans
*Learning Curve
Lumbar Vertebrae/*surgery
Male
Middle Aged
Minimally Invasive Surgical Procedures/adverse effects/methods
Retrospective Studies
Spinal Diseases/*surgery
Spinal Fusion/*adverse effects/methods
Young Adult

Figure

• 

  Fig. 1 Eight complications occurred in the first one-third of the series (patients #5, #11, #13, #18, #27, #36, #39, and #45) and only 3 complications occurred in the last two-thirds of the series (patients #70, #117, and #121).

• 

  Fig. 2 A medially misplaced screw in the right side L4 pedicle demonstrated symptomatic L4 radiculopathy (arrow) in the postoperative radiography (A) and axial view of computed tomography scan (B).

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  Fig. 3 Postoperative sagittal view (A) and axial view of computed tomography scan (B) show posteriorly migrated cage impinging the right side L5 nerve root (arrows) and causing postoperative radicular leg pain.

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  Fig. 4 Bony fragments were extruded (arrows) from the previously grafted bone material in the interbody space (A) and were irritating the traversing nerve root causing postoperative lumbar radiculopathy (B).

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