Nationwide Survey on Surgical Complications Associated with Lateral Lumbar Interbody Fusion in 2017

Abstract

Introduction: Recently, lateral lumbar interbody fusion (LIF), including extreme lateral interbody fusion (XLIF), direct lateral interbody fusion (DLIF), and oblique lateral interbody fusion (OLIF), has been introduced in Japan. Despite the effectiveness of the procedure, several complications related to this procedure have been reported. Since 2015, to identify the overall complication rate and type of LIF, the Japanese Society for Spine Surgery and Related Research (JSSR) has started a nationwide survey on the incidence and type of complications related to LIF among all JSSR members. We report on the results of the nationwide survey conducted by JSSR on the complications associated with LIF performed in Japan in 2017.

Methods: A web-based nationwide survey on the complications following LIF was conducted by JSSR for all JSSR members. Any complications meeting the following criteria were included: 1. major vessel injury, 2. urinary tract injury, 3. renal injury, 4. visceral organ injury, 5. lung injury, 6. weakness of psoas, 7. motor deficit, 8. sensory deficit, 9. vertebral injury, 10. nerve injury, 11. anterior longitudinal ligament injury, 12. surgical site infection (SSI), and 13. other complications. The incidence and type of LIF were analyzed among all patients who underwent LIF, and the differences in the incidence and type of complications between XLIF and OLIF were compared.

Results: Among 2,311 patients who underwent LIF [XLIF: 906 cases (39.2%), DLIF: 50 cases (2.2%), and OLIF: 1,355 cases (58.6%) ], complications were observed in 72 patients (3.1%). The most common complication was sensory deficit (0.74%), followed by motor deficit (0.35%), SSI (0.30%), weakness of psoas (0.22%), nerve injury (0.22%), and major vessel injury (0.09%). Ten patients (0.4%) required revision surgery during the survey period. There was no statistically significant difference in the frequency of resultant complications between XLIF and OLIF (3.8% vs. 3.0%, p = 0.34).

Conclusions: We conducted a nationwide survey on the complications that occur following LIF. The overall complication rate was 3.1%, and 0.4% patients required revision surgery for the complications. Major vessel injury occurred in 0.09%, nerve injury occurred in 0.22%, and SSI occurred in 0.30% patients.