Perioperative complications associated with minimally invasive surgery of oblique lumbar interbody fusions for degenerative lumbar diseases in 113 patients.

OBJECTIVES

To describe perioperative complications occurring during oblique lumbar interbody fusion (OLIF) assisted by a retractor system for degenerative lumbar diseases.

PATIENTS AND

METHODS

The perioperative complications in 113 cases series utilizing a minimally invasive approach were recorded and analyzed. One hundred thirteen patients who received OLIF for degenerative lumbar diseases between November 2014 and February 2017 at a single center were evaluated. The most frequent diagnosis was spondylolisthesis (59 cases, 52.2%), followed by lumbar instability (24 cases, 21.2%), adjacent segmental disease (12 cases, 10.6%), adult degenerative scoliosis (11 cases, 9.8%) and discogenic low back pain (7 cases, 6.2%). One hundred thirty-four levels were treated, 88.5% one-level, 4.4% two-level, and 7.1% three-level surgeries. The most fused level was L4-5 (94 levels, 70.2%), followed by L3-4 (31 levels, 23.1%), and L2-3 (9 levels, 6.7%).

RESULTS

All perioperative complications only included adverse events related to the OLIF procedure. The most observed complications were donor-site pain (24 cases, 21.2%), followed by vertebral endplate fracture (15 cases, 13.3%), thigh numbness/pain (12 cases, 10.6%), psoas/quadriceps weakness (5 cases, 4.4%), sympathetic nerve injury (2 case, 1.8%), paralytic ileus (one case, 0.9%), segmental artery injury (one case, 0.9%), intervertebral infection (one, 0.9%), and contralateral femoral nerve palsy (one, 0.9%). All complications, including postoperative ipsilateral or contralateral thigh paresthesia, pain, and psoas/quadriceps weakness, were observed when operating at L4-L5. The incidence of complications excluding donor-site pain was 24.8% (28/113 cases). The patients with donor-site pain, thigh numbness/pain, psoas/quadriceps weakness, sympathetic nerve injury and paralytic ileus recovered within two months following surgery. The patient with intervertebral infection recovered at 3 months after surgery. One case of contralateral femoral nerve palsy recovered completely with no residual sensory or motor deficit at 6 months.

CONCLUSIONS

OLIF performed using a retractor system is a validated option to treat a wide spectrum of degenerative lumbar diseases with few perioperative complications and a quick recovery. Judicious use of this technique at the L4/5 level is recommended. Close attention to detail during the procedure can minimize complications that may be associated with the learning curve.