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COMPLICATIONS IN 710 XLIF SURGERIES: SP11.

Rodgers, W. B. M.D.; Gerber, Edward J P.A.‐C.; Patterson, Jamie B.S.

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Spine Midwest, Jefferson City, Missouri, USA

INTRODUCTION: The XLIF procedure allows for minimally invasive placement of a large anterior graft, disk height and alignment restoration, and indirect decompression.

METHODS: Our single‐site consecutive series of 710 XLIF outcomes were reviewed. Surgical and postoperative complications were documented.

RESULTS: Patients age 22‐89 (average 62 years). Diagnoses included stenosis (51%), spondylolisthesis (15%), DDD (12%), HNP (9%), post‐laminectomy instability (6%), and scoliosis (8%). 84% had pre‐existing comorbidities; 41% had prior lumbar surgery. 367 (52%) were obese or morbidly obese. 884 levels were treated: 78% single‐level; 59% at L4‐5. 99.3% included supplemental instrumentation. Hospital stay averaged 1.20 days. 49 complications were reported: (6.9% complication rate): 3 wound (hernia, subcutaneous hematoma, infection); 7 GI (6 ileus, 1 gastric volvulus); 3 renal (1 urinary retention, 1 UTI, 1 peritoneal catheter occlusion); 7 respiratory (4 pneumonia, 2 pulmonary embolism, 1 re‐intubation); 7 cardiac (6 atrial fibrillations, 1 MI at 6 wks post‐op); 4 neural (3 transient quad weakness, 1 transient anterior tibialis weakness); 12 vertebral body fractures (1 endplate fracture, 1 osteophyte fracture requiring reoperation, 1 subsidence requiring reoperation, 5 compression fractures at an adjacent level requiring vertebroplasty); 1 iatrogenic HNP (requiring laminectomy at 4 wks); 1 hnp at adjacent level (requiring discectomy), 2 sacral fractures (no treatment); and 6 hardware failures. Reoperation rate was 50/710 (7.0%) (7 vertebroplasty, 7 axia LIF, 14 XLIF, 5 PLIF, 1 ALIF, 11 laminectomy, 1 hardware revision, 1 hardware removal, 1 hematoma drainage, 1 stimulator). Average VAS scores, radiographic measures, and fusion scores were not different between the complications group and the total series.

Pretreatment with Decadron was found to significantly reduce neuropraxia, P=0.0245. Since premedication with Decadron began, no neural complications have been reported.

DISCUSSION: XLIF is a safe, effective treatment for multiple thoracolumbar degenerative conditions. XLIF surgery can be performed in many conditions with a low complication rate.

© 2010 Lippincott Williams & Wilkins, Inc.

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