Low risk of “catastrophic” complications with minimally invasive lateral lumbar interbody fusion

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According to a study presented at IMAST, minimally invasive lateral lumbar interbody fusion is a safe and reproducible alternative to other interbody fusion procedures and is associated with a low risk of catastrophic complications

Juan Uribe, assistant professor of Neurosurgery, Department of Neurological Surgery, University of South Florida, Tampa, USA, told IMAST delegates: “Minimally invasive lateral lumbar interbody fusion is becoming popular and it seems to be safe and reproducible. However, the most frequent complication is related to lumbar plexus nerve injuries and we know that the surgical corridor lies in close proximity to key peritoneal/vascular structures that are at risk for injury.” He added that bowel and vascular complications of the technique had not yet been reported and, therefore, the objective of the study was to examine the incidence of catastrophic complications following minimally invasive lateral lumbar fusion (using XLIF, extreme lumbar interbody fusion, from NuVasive).

Uribe explained that at a single academic institution, 425 cases in which patients had received minimally invasive lateral lumbar interbody fusion were retrospectively reviewed (performed by five surgeons between 2008 and 2011).The investigators evaluated the incidence of bowel perforation and major blood vessel injury (aorta, inferior vena cava, and common iliac vessels).

He said that there were no reported incidences of catastrophic complications in their patient population, and that, according to the results of their study, the risk of catastrophic complications with minimally invasive lumbar interbody fusion is low.  However, he added there was “potential for significant morbidity” with the technique and said that large multicentre studies were needed to understand and prevent these potential complications.

Uribe concluded his report by revealing the interim results of the SOLAS member survey, which is also investigating the incidence of catastrophic complications after minimally invasive lateral lumbar interbody fusion using XLIF. He said that to date, 10,432 cases have been collected, from 2003 to July 2012, and that there has been: “Six (<0.01%) vascular injury reports and 10 (<0.01%) visceral injury reports.” He added that they expect, eventually, to collect data for up to 20,000 patients who have undergone the procedure.