Complications in minimally invasive transforaminal lumbar interbody fusion remain rare with durotomy the most common

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A study published by the Journal of Neurosurgery: Spine has provided a review of the complications association with minimally invasive transforaminal lumbar interbody fusion (TLIF). The study found that the most common complication was a durotomy.

The TLIF procedure has become one of the preferred procedures for circumferential fusion in the lumbar spine, especially over the last decade, as advances in surgical techniques have enabled surgeons to perform the TLIF through a minimally invasive approach. The authors of this study, led by Albert P Wong, Department of Neurological Surgery, Northwestern University, Chicago, USA, write that the review “is the largest study of perioperative complications in minimally invasive TLIF in the literature”, involving 513 consecutive lumbar degenerative disc disease patients treated over a 10-year period. Demographic, intraoperative, and perioperative data were collected and analysed using bivariate analyses (Student t-test, analysis of variance, odds ratio, chi-square test) and multivariate analyses (logistic regression).

The perioperative complication rate across all 531 patients was reported at 15.6% (80 complications). The incidence of durotomy—the most common complication—was 5.1%, and the medical and surgical infection rates were 1.4% and 0.2%, respectively. A statistically significant increase in the infection rate was seen in revision cases, and the same was found for the perioperative complication rate in multilevel cases. Instrumentation failure occurred in 2.3% of the cases. After analysis, no statistically significant difference was seen in the rates of durotomy during revision and multilevel surgeries. There was no significant difference between the complication rates when stratified according to presenting diagnosis.

In order to avoid durotomies, Wong and colleagues recommend that a “definitive and safe plane should be developed between the bony elements or ligaments and thecal sacs”. They also recommend that the biting window of the rongeur should be “turned 180 degrees away from the thecal sac with gentle upward traction” after having clearly identified the thecal sac and nerve roots before incision or resection of the annulus fibrous. The authors make clear that “none of the patients in our study who underwent minimally invasive TLIF and had a durotomy required postoperative intervention for a cerebrospinal fluid leak”, which they believe is “a major advantage of the minimally invasive procedure”.

Wong et al write that, comparing their results with the existing literature regarding open TLIFs, “minimally invasive TLIF has a similar or better perioperative complication profile than those documented in the literature for open TLIF treatment of degenerative lumbar spine disease.”

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