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A Systematic Review of Complications Following Minimally Invasive Spine Surgery Including Transforaminal Lumbar Interbody Fusion

  • Hannah Weiss
  • Roxanna M. Garcia
  • Ben Hopkins
  • Nathan Shlobin
  • Nader S. DahdalehEmail author
Minimally Invasive Spine Surgery (W Hsu, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Minimally Invasive Spine Surgery

Abstract

Purpose of Review

To assess complications after minimally invasive spinal surgeries including transforaminal lumbar interbody fusion (MI-TLIF) by reviewing the most recent literature.

Recent Findings

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%).

Summary

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.

Keywords

Minimally invasive Spine Transforaminal lumbar interbody fusion (TLIF) Complications Systematic review 

Notes

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.

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    Deyo RA, Mirza SK, Martin BI. Back pain prevalence and visit rates: estimates from US national surveys, 2002. Spine. 2006;31:2724–7.CrossRefGoogle Scholar
  2. 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
  3. 3.
    Phan K, Rao PJ, Kam AC, Mobbs RJ. Minimally invasive versus open transforaminal lumbar interbody fusion for treatment of degenerative lumbar disease: systematic review and meta-analysis. Eur Spine J. 2015;24:1017–30.CrossRefGoogle Scholar
  4. 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. 5.
    Maroon JC. Current concepts in minimally invasive discectomy. Neurosurgery. 2002;51(supplement 2):S137–45.Google Scholar
  6. 6.
    Nerland US, Jakola AS, Solheim O, Weber C, Rao V, Lonne G, et al. Minimally invasive decompression versus open laminectomy for central stenosis of the lumbar spine: pragmatic comparative effectiveness study. BMJ. 2015;350:h1603.CrossRefGoogle Scholar
  7. 7.
    Perez-Cruet MJ, Fessler RG, Perin NI. Complications of minimally invasive spine surgery. Neurosurgery. 2002;51(supplement 2):S26–36.Google Scholar
  8. 8.
    Karikari IO, Isaacs RE. Minimally invasive transforaminal lumbar interbody fusion: a review of techniques and outcomes. Spine. 2010;35(26S):S294–301.CrossRefGoogle Scholar
  9. 9.
    Senker W, Gruber A, Gmeiner M, Stefanits H, Sander K, Rössler P, et al. Surgical and clinical results of minimally invasive spinal fusion surgery in an unselected patient cohort of a spinal care unit. Orthop Surg. 2018;10:192–7.CrossRefGoogle Scholar
  10. 10.
    Fan G, Fu Q, Zhang J, Zhang H, Gu X, Wang C, et al. Radiation reduction of minimally invasive transforaminal lumbar interbody fusion with localisation system in overweight patients: practical technique. Bone Joint J. 2017;99-B:944–50.CrossRefGoogle Scholar
  11. 11.
    Singh K, Bohl DD, Ahn J, Massel DH, Mayo BC, Narain AS, et al. Multimodal analgesia versus intravenous patient-controlled analgesia for minimally invasive transforaminal lumbar interbody fusion procedures. Spine. 2017;42:1145–50.CrossRefGoogle Scholar
  12. 12.
    Li Y-B, Wang X-D, Yan H-W, Hao D-J, Liu Z-H. The long-term clinical effect of minimal-invasive TLIF technique in 1-segment lumbar disease. Clin Spine Surg. 2017;30:E713–9.CrossRefGoogle Scholar
  13. 13.
    Liu C, Zhou Y. Percutaneous endoscopic lumbar Diskectomy and minimally invasive transforaminal lumbar interbody fusion for recurrent lumbar disk herniation. World Neurosurg. 2017;98:14–20.CrossRefGoogle Scholar
  14. 14.
    Tay KS, Bassi A, Yeo W, Yue WM. Associated lumbar scoliosis does not affect outcomes in patients undergoing focal minimally invasive surgery-transforaminal lumbar interbody fusion (MISTLIF) for neurogenic symptoms-a minimum 2-year follow-up study. Spine J. 2017;17:34.CrossRefGoogle Scholar
  15. 15.
    Bakhsheshian J, Khanna R, Choy W, Lawton CD, Nixon AT, Wong AP, et al. Incidence of graft extrusion following minimally invasive transforaminal lumbar interbody fusion. J Clin Neurosci. 2016;24:88–93.CrossRefGoogle Scholar
  16. 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. 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. 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
  19. 19.
    Scheer JK, Khanna R, Lopez AJ, Fessler RG, Koski TR, Smith ZA, et al. The concave versus convex approach for minimally invasive lateral lumbar interbody fusion for thoracolumbar degenerative scoliosis. J Clin Neurosci. 2015;22:1588–93.CrossRefGoogle Scholar
  20. 20.
    Park Y, Lee SB, Seok SO, Jo BW, Ha JW. Perioperative surgical complications and learning curve associated with minimally invasive transforaminal lumbar interbody fusion: a single-institute experience. Clin Orthop Surg. 2015;7:91–6.CrossRefGoogle Scholar
  21. 21.
    Eckman WW, Hester L, McMillen M. Same-day discharge after minimally invasive transforaminal lumbar interbody fusion: a series of 808 cases. Clin Orthop Relat Res. 2014;472:1806–12.CrossRefGoogle Scholar
  22. 22.
    Park Y, Ha JW, Lee YT, Sung NY. Minimally invasive transforaminal lumbar interbody fusion for spondylolisthesis and degenerative spondylosis: 5-year results. Clin Orthop Relat Res. 2014;472:1813–23.CrossRefGoogle Scholar
  23. 23.
    Perez-Cruet MJ, Hussain NS, White GZ, Begun EM, Collins RA, Fahim DK, et al. Quality-of-life outcomes with minimally invasive transforaminal lumbar interbody fusion based on long-term analysis of 304 consecutive patients. Spine. 2014;39:E191–8.CrossRefGoogle Scholar
  24. 24.
    Smith ZA, Sugimoto K, Lawton CD, Fessler RG. Incidence of lumbar spine pedicle breach after percutaneous screw fixation: a radiographic evaluation of 601 screws in 151 patients. J Spinal Disord Tech. 2014;27:358–63.CrossRefGoogle Scholar
  25. 25.
    Wang J, Zhou Y. Perioperative complications related to minimally invasive transforaminal lumbar fusion: evaluation of 204 operations on lumbar instability at single center. Spine J. 2014;14:2078–84.CrossRefGoogle Scholar
  26. 26.
    Wong AP, Shih P, Smith TR, Slimack NP, Dahdaleh NS, Aoun SG, et al. Comparison of symptomatic cerebral spinal fluid leak between patients undergoing minimally invasive versus open lumbar foraminotomy, discectomy, or laminectomy. World Neurosurg. 2014;81:634–40.CrossRefGoogle Scholar
  27. 27.
    Kim M-C, Chung H-T, Cho J-L, Kim D-J, Chung N-S. Subsidence of polyetheretherketone cage after minimally invasive transforaminal lumbar interbody fusion. J Spinal Disord Tech. 2013;26:87–92.CrossRefGoogle Scholar
  28. 28.
    Lau D, Ziewacz J, Park P. Minimally invasive transforaminal lumbar interbody fusion for spondylolisthesis in patients with significant obesity. J Clin Neurosci. 2013;20:80–3.CrossRefGoogle Scholar
  29. 29.
    Silva PS, Pereira P, Monteiro P, Silva PA, Vaz R. Learning curve and complications of minimally invasive transforaminal lumbar interbody fusion. Neurosurg Focus. 2013;35:E7.CrossRefGoogle Scholar
  30. 30.
    Singh K, Nandyala SV, Marquez-Lara A, Cha TD, Khan SN, Fineberg SJ, et al. Clinical sequelae after rhBMP-2 use in a minimally invasive transforaminal lumbar interbody fusion. Spine J. 2013;13:1118–25.CrossRefGoogle Scholar
  31. 31.
    Kim M-C, Chung H-T, Cho J-L, Kim D-J, Chung N-S. Factors affecting the accurate placement of percutaneous pedicle screws during minimally invasive transforaminal lumbar interbody fusion. Eur Spine J. 2011;20:1635–43.CrossRefGoogle Scholar
  32. 32.
    Rouben D, Casnellie M, Ferguson M. Long-term durability of minimal invasive posterior transforaminal lumbar interbody fusion: a clinical and radiographic follow-up. J Spinal Disord Tech. 2011;24:288–96.CrossRefGoogle Scholar
  33. 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
  34. 34.
    Rosen DS, Ferguson SD, Ogden AT, Huo D, Fessler RG. Obesity and self-reported outcome after minimally invasive lumbar spinal fusion surgery. Neurosurgery. 2008;63:956–60 discussion 960.CrossRefGoogle Scholar
  35. 35.
    Pereira C, Santos Silva P, Cunha M, Vaz R, Pereira P. How does minimally invasive transforaminal lumbar interbody fusion influence lumbar radiologic parameters? World Neurosurg. 2018;116:e895–902.CrossRefGoogle Scholar
  36. 36.
    Ahn J, Massel DH, Mayo BC, Hijji FY, Narain AS, Aboushaala K, et al. The utility of routinely obtaining postoperative laboratory studies following a minimally invasive transforaminal lumbar interbody fusion. Clin Spine Surg. 2017;30:E1405–10.CrossRefGoogle Scholar
  37. 37.
    Kukreja S, Haydel J, Nanda A, Sin AH. Impact of body habitus on fluoroscopic radiation emission during minimally invasive spine surgery. J Neurosurg Spine. 2015;22:211–8.CrossRefGoogle Scholar
  38. 38.
    Ahn J, Bohl DD, Elboghdady I, Aboushaala K, Mayo BC, Hassanzadeh H, et al. Postoperative narcotic consumption in Workman’s compensation patients following a minimally invasive transforaminal lumbar interbody fusion. Spine. 2015;40:1284–8.CrossRefGoogle Scholar
  39. 39.
    Siemionow K, Pelton MA, Hoskins JA, Singh K. Predictive factors of hospital stay in patients undergoing minimally invasive transforaminal lumbar interbody fusion and instrumentation. Spine. 2012;37:2046–54.CrossRefGoogle Scholar
  40. 40.
    Tian N-F, Wu YS, Zhang XL, Xu HZ, Chi YL, Mao FM. Minimally invasive versus open transforaminal lumbar interbody fusion: a meta-analysis based on the current evidence. Eur Spine J. 2013;22:1741–9.CrossRefGoogle Scholar
  41. 41.
    Wu RH, Fraser JF, Härtl R. Minimal access versus open transforaminal lumbar interbody fusion: meta-analysis of fusion rates. Spine. 2010;35:2273–81.CrossRefGoogle Scholar
  42. 42.
    Goldstein CL, Macwan K, Sundararajan K, Rampersaud YR. Comparative outcomes of minimally invasive surgery for posterior lumbar fusion: a systematic review. Clin Orthop Relat Res. 2014;472:1727–37.CrossRefGoogle Scholar
  43. 43.
    Foley KT, Gupta SK. Percutaneous pedicle screw fixation of the lumbar spine: preliminary clinical results. J Neurosurg. 2002;97:7–12.Google Scholar
  44. 44.
    Mobbs RJ, Sivabalan P, Li J. Minimally invasive surgery compared to open spinal fusion for the treatment of degenerative lumbar spine pathologies. J Clin Neurosci. 2012;19:829–35.CrossRefGoogle Scholar
  45. 45.
    Scheer JK, Harvey MJ, Dahdaleh NS, Smith ZA, Fessler RG. K-wire fracture during minimally invasive transforaminal lumbar interbody fusion: report of six cases and recommendations for avoidance and management. Surg Neurol Int. 2014;5:S520–2.CrossRefGoogle Scholar
  46. 46.
    Patel N, Bagan B, Vadera S, Maltenfort MG, Deutsch H, Vaccaro AR, et al. Obesity and spine surgery: relation to perioperative complications. J Neurosurg Spine. 2007;6:291–7.CrossRefGoogle Scholar
  47. 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. 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
  49. 49.
    Fujita T, Kostuik JP, Huckell CB, Sieber AN. Complications of spinal fusion in adult patients more than 60 years of age. Orthop Clin North Am. 1998;29:669–78.CrossRefGoogle Scholar
  50. 50.
    Dakwar E, Cardona RF, Smith DA, Uribe JS. Early outcomes and safety of the minimally invasive, lateral retroperitoneal transpsoas approach for adult degenerative scoliosis. Neurosurg Focus. 2010;28:E8.CrossRefGoogle Scholar
  51. 51.
    Phillips FM, Isaacs RE, Rodgers WB, Khajavi K, Tohmeh AG, Deviren V, et al. Adult degenerative scoliosis treated with XLIF: clinical and radiographical results of a prospective multicenter study with 24-month follow-up. Spine. 2013;38:1853–61.CrossRefGoogle Scholar
  52. 52.
    Castro C, Oliveira L, Amaral R, Marchi L, Pimenta L. Is the lateral transpsoas approach feasible for the treatment of adult degenerative scoliosis? Clin Orthop Relat Res. 2014;472:1776–83.CrossRefGoogle Scholar
  53. 53.
    Rahman M, Summers LE, Richter B, Mimran RI, Jacob RP. Comparison of techniques for decompressive lumbar laminectomy: the minimally invasive versus the ‘classic’ open approach. Minim Invasive Neurosurg. 2008;51:100–5.CrossRefGoogle Scholar
  54. 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
  55. 55.
    Montano N, Stifano V, Papacci F, Mazzucchi E, Fernandez E. Minimally invasive decompression in patients with degenerative spondylolisthesis associated with lumbar spinal stenosis. Report of a surgical series and review of the literature. Neurol Neurochir Pol. 2018;52:448–58.CrossRefGoogle Scholar
  56. 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.
  57. 57.
    Grossbach AJ, Dahdaleh NS, Abel TJ, Woods GD, Dlouhy BJ, Hitchon PW. Flexion-distraction injuries of the thoracolumbar spine: open fusion versus percutaneous pedicle screw fixation. Neurosurg Focus. 2013;35:E2.CrossRefGoogle Scholar
  58. 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
  59. 59.
    Wang B, Fan Y, Dong J, Wang H, Wang F, Liu Z, et al. A retrospective study comparing percutaneous and open pedicle screw fixation for thoracolumbar fractures with spinal injuries. Medicine (Baltimore). 2017;96:e8104.CrossRefGoogle Scholar
  60. 60.
    Zhao Q, Zhang H, Hao D, Guo H, Wang B, He B. Complications of percutaneous pedicle screw fixation in treating thoracolumbar and lumbar fracture. Medicine (Baltimore). 2018;97:e11560.CrossRefGoogle Scholar
  61. 61.
    Sclafani JA, Kim CW. Complications associated with the initial learning curve of minimally invasive spine surgery: a systematic review. Clin Orthop Relat Res. 2014;472:1711–7.CrossRefGoogle Scholar
  62. 62.
    Lee JC, Jang H-D, Shin B-J. Learning curve and clinical outcomes of minimally invasive transforaminal lumbar interbody fusion: our experience in 86 consecutive cases. Spine. 2012;37:1548–57.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Hannah Weiss
    • 1
  • Roxanna M. Garcia
    • 1
    • 2
  • Ben Hopkins
    • 1
  • Nathan Shlobin
    • 3
  • Nader S. Dahdaleh
    • 1
    Email author
  1. 1.Department of NeurosurgeryNorthwestern UniversityChicagoUSA
  2. 2.Institute for Public Health and Medicine (IPHAM), Center for Healthcare StudiesNorthwestern UniversityChicagoUSA
  3. 3.Northwestern UniversityChicagoUSA

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