General Session: MIS-1
Presented by: F. Hijji - View Audio/Video Presentation (Members Only)
F. Hijji(1), A. Narain(1), D. Bohl(1), J. Ahn(1), W. Long(1), J. DiBattista(1), K. Kudaravalli(1), K. Yom(1), K. Singh(1)
(1) Rush University Medical Center, Orthopaedic Surgery, Chicago, IL, United States
Introduction: Lateral lumbar interbody fusion (LLIF) is a frequently utilized technique for the treatment of lumbar pathology. Despite its overall success, LLIF has been reported to exhibit a unique set of complications. However, there has been inconsistent evidence regarding this approach's overall complication rate. In this context, the purpose of this study is to perform a systematic review analyzing the rates of medical and surgical complications associated with this procedure.
Methods: This systematic review was performed utilizing the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Relevant studies that identified rates of any complication following LLIF procedures were obtained from Pubmed, Medline, and EMBASE databases. Articles were excluded if they did not report complications, presented mixed complication data from other procedures, or were characterized as single case reports, reviews, or case series containing less than 10 patients. The primary outcome was frequency of complications within cardiovascular, vascular, pulmonary, urologic, gastrointestinal, transient neurologic, persistent neurologic, and musculoskeletal/spine (MSK) categories. All rates of complications were based on the sample sizes of studies that mentioned the respective complications.
Results: A total of 2212 articles were identified. Following screening of title, abstract, and full text availability, 63 articles were included in the review. There were a total 6819 patients with 11325 levels fused. The rate of complications for the categories included were as follows: wound (1.38%; 95% confidence interval [CI]=1.00-1.85%), cardiovascular (1.81%; CI=1.29-2.47%), vascular (0.81%; CI=0.44-1.36%), pulmonary (1.47; CI=0.95-2.16%), gastrointestinal (1.38%; CI=1.00-1.87%), urologic (0.93%; CI=0.55-1.47%), transient neurologic (36.07%; CI=34.74-37.41%), persistent neurologic (3.98%; CI=3.42-4.60%), and MSK/Spine (9.22%; CI=8.28-10.23%).
Conclusion: The current study is the first to comprehensively analyze the complication profile for LLIFs. As expected, the most significant complications were transient neurologic and MSK/spinal in nature. Comparable to other individual studies, transient hypoesthesia, thigh pain, and motor weakness were the most frequent complications. These common symptoms are likely related to the approach and involvement of the psoas muscle and lumbosacral plexus. However, persistent neurologic complications occurred at a much lower rate, bringing to question the significance of transient symptoms beyond the immediate postoperative period. Through this analysis of complication profiles, surgeons can better understand the risks and expectations for patients following LLIF procedures.