A Systematic Review of Complications Following Minimally Invasive Spine Surgery Including Transforaminal Lumbar Interbody Fusion
Purpose of Review
To assess complications after minimally invasive spinal surgeries including transforaminal lumbar interbody fusion (MI-TLIF) by reviewing the most recent literature.
Current literature demonstrates that minimally invasive surgery (MIS) in spine has improved clinical outcomes and reduced complications when compared with open spinal procedures. Recent studies describing MI-TLIF primarily for degenerative disk disease, spondylolisthesis, and vertebral canal stenosis cite over 89 discrete complications, with the most common being radiculitis (ranging from 2.8 to 57.1%), screw malposition (0.3–12.7%), and incidental durotomy (0.3–8.6%).
Minimally invasive spine surgery has a distinct set of complications in comparison with other spinal procedures. These complications vary based on the exact MIS procedure and indication. The most frequently documented MI-TLIF complications in current published literature were radiculitis, screw malposition, and incidental durotomy.
KeywordsMinimally invasive Spine Transforaminal lumbar interbody fusion (TLIF) Complications Systematic review
Compliance with Ethical Standards
Conflict of Interest
Hannah Weiss, Roxanna Garcia, Ben Hopkins, Nathan Shlobin, and Nader Dahdaleh declare that they have no conflict of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
- 2.Khan NR, et al. Surgical outcomes for minimally invasive vs open transforaminal lumbar interbody fusion: an updated systematic review and meta-analysis. Neurosurgery. 77:847–74 discussion 874 (2015).Google Scholar
- 4.••Xie L, Wu W-J, Liang Y. Comparison between Minimally Invasive Transforaminal Lumbar Interbody Fusion and Conventional Open Transforaminal Lumbar Interbody Fusion: An Updated Meta-analysis. Chin Med J. 2016;129:1969–86 This recent meta-analysis provides one of the most updated reviews of the literature on open-TLIF vs MIS-TLIF. The findings indicated that MIS-TLIF has fusion rates similar to open-TLIF, but with better functional outcome, decreased blood loss, decreased time to ambulation, and decreased length of hospital stay when compared with patients undergoing open-TLIF.Google Scholar
- 5.Maroon JC. Current concepts in minimally invasive discectomy. Neurosurgery. 2002;51(supplement 2):S137–45.Google Scholar
- 7.Perez-Cruet MJ, Fessler RG, Perin NI. Complications of minimally invasive spine surgery. Neurosurgery. 2002;51(supplement 2):S26–36.Google Scholar
- 16.••Wong AP, Smith ZA, Nixon AT, Lawton CD, Dahdaleh NS, Wong RH, et al. Intraoperative and perioperative complications in minimally invasive transforaminal lumbar interbody fusion: a review of 513 patients. J Neurosurg Spine. 2015;22:487–95 Wong et al. provide one of the largest reviews patients undergoing MI-TLIF surgery for lumbar degenerative disc disease. By analyzing over 500 patients, they sought to determine the associated intraoperative and perioperative complications, found most commonly to be durotomy, instrumentation failure, infection. Revision MI-TLIF and multi-level MI-TLIF procedures were associated with higher perioperative complications.CrossRefGoogle Scholar
- 17.Giorgi H, Prébet R, Delhaye M, Aurouer N, Mangione P, Blondel B, et al. Minimally invasive posterior transforaminal lumbar interbody fusion: one-year postoperative morbidity, clinical and radiological results of a prospective multicenter study of 182 cases. Orthop Traumatol Surg Res. 2015;101:S241–5.CrossRefGoogle Scholar
- 18.Klingler J-H, Volz F, Krüger MT, Kogias E, Rölz R, Scholz C, et al. Accidental durotomy in minimally invasive transforaminal lumbar interbody fusion: frequency, risk factors, and management. ScientificWorldJournal. 2015;2015:532628.Google Scholar
- 33.Matsumoto M, Hasegawa T, Ito M, Aizawa T, Konno S, Yamagata M, et al. Incidence of complications associated with spinal endoscopic surgery: nationwide survey in 2007 by the committee on spinal endoscopic surgical skill qualification of Japanese Orthopaedic Association. J Orthop Sci. 2010;15:92–6.CrossRefGoogle Scholar
- 43.Foley KT, Gupta SK. Percutaneous pedicle screw fixation of the lumbar spine: preliminary clinical results. J Neurosurg. 2002;97:7–12.Google Scholar
- 47.•Xie Q, et al. Minimally invasive versus open Transforaminal lumbar Interbody fusion in obese patients: a meta-analysis. BMC Musculoskelet Disord. 2018;19:15 This meta-analysis aimed to describe whether MI-TLIF or open-TLIF had improved perioperative, functional, and pain outcomes specifically in obese patients. MI-TLIF was associated with decreased operative time, blood loss, postoperative drainage, complications, and length of stay.CrossRefGoogle Scholar
- 48.Avila MJ, Walter CM, Baaj AA. Outcomes and complications of minimally invasive surgery of the lumbar spine in the elderly. Cureus. 2016;8:e519.Google Scholar
- 54.Mobbs RJ, Li J, Sivabalan P, Raley D, Rao PJ. Outcomes after decompressive laminectomy for lumbar spinal stenosis: comparison between minimally invasive unilateral laminectomy for bilateral decompression and open laminectomy: clinical article. J Neurosurg Spine. 2014;21:179–86.CrossRefGoogle Scholar
- 56.Rasouli MR, Rahimi-Movaghar V, Shokraneh F, Moradi-Lakeh M, Chou R. Minimally invasive discectomy versus microdiscectomy/open discectomy for symptomatic lumbar disc herniation. Cochrane Database Syst Rev. 2014;9:CD010328. https://doi.org/10.1002/14651858.CD010328.
- 58.• Tian F, et al. Percutaneous versus open pedicle screw instrumentation in treatment of thoracic and lumbar spine fractures: a systematic review and meta-analysis. Medicine (Baltimore). 2018;97:e12535 The aim of this meta-analysis was to compare percutaneous posterior pedicle screw procedures with open posterior pedicle screw procedures in the setting of traumatic thoracolumbar fractures. Percutaneous procedures were found to be associated with decreased postoperative pain, blood loss, operating time, length of hospital stay, and incision size, yet no significant difference in radiologic outcomes or method-related complications. This study provides evidence for the use of minimally invasive techniques beyond elective surgery to surgery for traumatic etiologies.CrossRefGoogle Scholar