Postoperative Complications Within the First Year After Extreme Lateral Interbody Fusion Experience of the First 108 Patients

Study Design: Retrospective chart review. Objective: To determine complications within the first year after undergoing extreme lateral interbody fusion (XLIF). Summary of Background Data: There are a growing but limited number of reports in the literature regarding early postoperative complications after XLIF. Methods: We performed a retrospective chart review of perioperative complications of a case series of the first 108 patients to undergo XLIF at our institution between 2007 and 2009. We also recorded estimated blood loss, surgical time, and hospital length of stay for each procedure. Results: There were 25 complications (23%) overall in patients who underwent the XLIF procedure. Four patients (3.7%) experienced major complications including: vertebral body fracture, contralateral nerve root injury, dense quadriceps paresis, and persistent stenosis. Three of these patients underwent revision surgery. There were 21 minor (19.4%) complications the vast majority of which consisted of approach-related thigh pain and/or paresthesias that all ultimately resolved. Conclusions: Transient ipsilateral thigh numbness, pain, and/or hip flexor weakness is a frequent postoperative finding most commonly when the L4-L5 level is instrumented. Dense femoral nerve palsy is a debilitating complication that may occur despite intraoperative neurophysiological monitoring. It should be noted that this retrospective study may underreport the true incidence of complications among these patients.