Risk Factors for Medical and Surgical Complications After Single-Level Minimally Invasive Transforaminal Lumbar Interbody Fusion

Abstract

Background: The prevention of perioperative and postoperative complications is necessary to avoid poor postoperative outcomes and increased costs. Previous investigations have identified risk factors for complications after various spine procedures, but no such study exists in a population solely undergoing minimally invasive transforaminal lumbar interbody fusion (MIS TLIF). The purpose of this study is to determine risk factors for the development of complications up to 2 years after MIS TLIF procedures. Methods: Patients who underwent primary, single-level MIS TLIF from 2007 to 2016 were retrospectively reviewed. The incidence of medical and surgical complications up to 2 years postoperatively was determined. Patients were categorized according to demographic, comorbidity, and procedural characteristics. Bivariate Poisson regression with robust error variance was used to determine if an association existed between patient characteristics and complication incidence. A final multivariate model including all patient characteristics as controls was created using backwards, stepwise regression until only those variables with P , .05 remained. Results: 390 patients were analyzed. Upon bivariate analysis, age .50 years (P ¼ .025), diabetes mellitus (P ¼ .001), and operative duration .105 minutes (P ¼ .016) were associated with increased medical complication rates. Regarding surgical complications, age 50 years (P , .001), obesity (P ¼ .012), and diabetes mellitus (P ¼ .042) were identified as risk factors on bivariate analysis. Upon final multivariate analysis, operative time .105 minutes (P ¼ .009) and diabetes mellitus (P ¼ .001) were independent risk factors for medical complications. Independent risk factors for surgical complications on multivariate analysis included age 50 years (P , .001), diabetes mellitus (P ¼ .002), and obesity (P ¼ .030). Conclusions: Diabetic patients and those who underwent longer operations were at increased risk of medical complications, while younger patients, obese patients and those also with diabetes mellitus were at increased risk of surgical complications up to 2 years after MIS TLIF. Practitioners can use this information to identify patients who require preventative care before their procedure or increased postoperative vigilance and monitoring after single-level MIS TLIF.

In Vivo Evidence of Early Instability and Late Stabilization in Motion Segments Immediately Superior to Anterior Cervical Arthrodesis

“…Historically, smoking and diabetes have been correlated with an increased rate of pseudoarthrosis, which would result in residual motion at the arthrodesis site and potentially reduce adjacent segment compensatory hypermobility 34–36. Our results partially support this theory.…”

The effect of anterior lumbar interbody fusion staging order on perioperative complications in circumferential lumbar fusions performed within the same hospital admission

“…In a separate model assessing postoperative complications, only age, BMI, and PSF duration were associated with the presence of a postoperative complication. Age and procedure duration are well-recognized risk factors, [10][11][12][13][14][15][16] and our group has previously identified obesity as a risk factor for postoperative complications after ALIF, particularly with respect to ileus, wound-related complications, and UTI. 17 Our typical institutional practice is to utilize an ALIFfirst approach, particularly for complex cases.…”

Minimally invasive transforaminal lumbar interbody fusion — A narrative review on the present status

“…The reported incidence of complications in MIS TLIF ranges from 11% to 31.37%. According to Narain et al 38 the most common non surgical complication was postoperative urinary retention (10.3%) and the most common surgical complication was pseudarthrosis requiring re-operation (8.7%). The predictors of medical complications were age greater than 50 years, diabetes and operative time greater than 105 min and the predictors of surgical complications were age less than 50 years, BMI >30 kg/m2 and diabetes.…”