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

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.