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Intraoperative and Early Postoperative Complications in Extreme Lateral Interbody Fusion: An Analysis of 600 Cases

Rodgers, W. Blake, MD; Gerber, Edward J., PA-C; Patterson, Jamie, BA

doi: 10.1097/BRS.0b013e3181e1040a
Clinical Case Series

Study Design. Prospective analysis of 600 extreme lateral interbody fusion (XLIF) approach procedures for intraoperative and perioperative complications.

Objective. To delineate and describe complications in a large, prospective series of minimally invasive lateral lumbar fusion procedures (XLIF).

Summary of Background Data. While some small series of lateral lumbar fusion have discussed complications, no results from large studies have been reported.

Methods. A total of 600 patients were treated with a lateral approach to fusion (XLIF) for degenerative spinal conditions. Data were collected prospectively on all patients and analyzed for demographic, diagnostic, and hospitalization information to identify operative and early postoperative complications. Documented complication types and rates in this large series were compared with smaller prior reports on lateral approach fusions, as well as other minimally invasive (mini-anterior lumbar interbody fusion and minimally invasive surgical [MIS] transforaminal lumbar interbody fusion) and more traditional fusion approaches (posterior intertransverse fusion, anterior lumbar interbody fusion, posterior lumbar interbody fusion, transforaminal lumbar interbody fusion).

Results. Seven hundred forty-one levels were treated, 80.8% single level, 15.0% 2 level, 4.0% 3 level, 0.2% 4 level; 59.3%, including the L4 to L5 levels. A total of 99.2% included supplemental internal fixation; 83.2% included pedicle screw fixation (predominantly unilateral). Hemoglobin change from pre- to postoperation averaged 1.38. Hospital stay averaged 1.21 days. The overall incidence of perioperative complications (intraoperation and out to 6 weeks postoperation) was 6.2%: 9 (1.5%) in-hospital surgery-related events, 17 (2.8%) in-hospital medical events, 6 (1.0%) out-of-hospital surgery-related events, and 5 (0.8%) out-of-hospital medical events. There were no wound infections, no vascular injuries, no intraoperative visceral injuries, and 4 (0.7%) transient postoperative neurologic deficits. Eleven events (1.8%) resulted in additional procedures/reoperation.

Conclusions. Compared with traditional open approaches, the MIS lateral approach to fusion by using the XLIF technique resulted in a lower incidence of infection, visceral and neurologic injury, and transfusion as well as markedly shorter hospitalization. Complications in MIS XLIF compare favorably with those from other MIS fusion procedures; duration of hospitalization is shorter than with any previously reported technique.

A prospective analysis of 600 extreme lateral lumbar fusion procedures demonstrated a low early-complication rate, comparing favorably with other minimally invasive techniques. The complication rate was lower than those reported previously with traditional open surgical approaches, resulting in a noteworthy comparative reduction in the length of hospitalization and blood loss.

From the Spine Midwest, Inc., Jefferson City, Missouri.

Address correspondence and reprint requests to Spine Midwest, Inc., 200 St. Mary's Plaza, Suite 301, Jefferson City, MO 65101; E-mail:

Acknowledgment date: November 18, 2009. First revision date: February 5, 2010. Second revision date: March 8, 2010. Acceptance date: March 31, 2010.

The device(s)/drug(s) is/are FDA-approved or approved by corresponding national agency for this indication.

No funds were received in support of this work.

One or more of the author(s) has/have received or will receive benefits for personal or professional use from a commercial party related directly or indirectly to the subject of this manuscript: e.g., honoraria, gifts, consultancies, royalties, stocks, stock options, decision making position.

Review and approval was granted for this study and report by the St. Mary's Medical Center institutional review board, Jefferson City, Missouri.

© 2011 Lippincott Williams & Wilkins, Inc.