Revision open transforaminal lumbar interbody fusion does not increase risk of perioperative complications


Imad Saeed Khan, Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, USA, and others wrote in the Journal of Neurosurgery: Spine that revision open transforaminal lumbar interbody fusion (TLIF) does not increase the risk of perioperative complications compared with primary open TLIF. However, a history of two of more prior lumbar decompression procedures does increase the risk of having a dural tear or sustaining a neural injury.

Khan et al explained that there has been “an increasing trend of employing TLIF to treat degenerative lumbar spine pathologies, including that in patients in whom earlier decompressive procedures have failed”. However, they added that, at present, “there is a dearth of literature on the differences in complication rates between primary TLIFs and revision TLIFs”. Therefore, they retrospectively reviewed the incidence of perioperative complications in patients who underwent open TLIF (both primary and revision) at their centre.

Of the 187 patients who were included in the study, 73 did not have a history of prior lumbar surgery and 114 did have a history of prior lumbar surgery (the most common being discectomy with or without laminectomy). Overall, 54 (28.9%) patients had an intraoperative or postoperative complication, with five being a major complication (“life-threatening, required a  reoperation, or left irreversible neurological side-effects) and 49 being a minor complication. Khan et al commented: “We could not show any difference in the incidence of complications (overall, major, or minor) between primary and revision open TLIF groups…we found that previous surgery was not independently associated with the incidence of adverse effects in revision surgeries (p=0.859).”

However when Khan et al further analysed the data, they found that patients who had undergone more than one previous lumbar decompressive surgery had a 3.2-fold increased risk of suffering an inadvertent dural tear than patients who had only one previous lumbar surgery or no previous lumbar surgeries (27.8% vs. 10.7%, respectively; p=0.052). Additionally, neural injury was significantly more common in patients who had more than one prior decompressive surgery compared with the other patients in the study (16.7% vs. 1.2%, respectively; p=0.007).

Study author Anil Nanda, Department of Neurosurgery, Louisiana State University Health Center, Shreveport, USA, told Spinal News International: “In our experience a single prior lumbar surgery does not significantly increase the risk of complications during a revision procedure. However, a history of two or more than two surgeries puts the patients at higher risk for dural tear and nerve root injury.”