Lateral lumbar interbody fusion complications

Reported complication rates for minimally invasive lateral transpsoas interbody fusion (MIS-LIF) vary widely.

The complication rate during the LLIF procedure has been reported to range from 2% to 30% with up to 20% minor and 8.6% major complications ^{1) 2) 3)}.

One type of minor complication that can be experienced is related to skin abrasion from tape as the patient is secured to the bed. Surgeons typically tape bony prominences by applying foam pads on the skin but not over truncal regions. Since the patient is asleep for the taping procedure, there is no knowledge about how much pressure applied to the skin can cause pain.

A second minor complication is the incidence of pain mimicking that of trochanteric bursitis presumably due to direct pressure of the greater trochanter against the table.

A major complication with LLIF is rhabdomyolysis or muscle necrosis due to prolonged soft tissue pressure which can lead to acute renal failure ⁴⁾. Rhabodmyolsis can be diagnosed by rising creatine phosphokinase levels and must be quickly identified to initiate appropriate medical treatment.

Intervertebral cage settling during bone remodeling after lumbar lateral interbody fusion (LIF) is a common occurrence during the normal healing process.

Malham et al. distinguished between early cage subsidence (ECS) and and delayed cage subsidence (DCS). Radiographic subsidence (DCS) was categorized using descriptors for the location and severity of the subsidence. Neither interbody fusion rates nor clinical outcomes were affected by radiographic subsidence. To protect patients from subsidence after MIS LIF, the surgeon needs to take care with the caudal endplate during cage insertion. If a caudal bilateral (Type 2) endplate breach is detected, supplemental posterior fixation to arrest progression and facilitate fusion is recommended ⁵⁾.

see Neurologic Injury after Lateral Lumbar Interbody Fusion.

It is not necessary to intervene for all patients in whom symptomatic pseudarthrosis is detected at 1 year postoperatively because only 11.9% of them will show persistent symptomatic pseudarthrosis. However, the early revision surgery should be considered when severe symptomatic pseudarthrosis associated with diabetes, smoking, and fusion at more than 3 levels is present. Level of Evidence 4 ⁶⁾.