Abstract:

The risk of perioperative complications while adopting minimally invasive spine surgery techniques may slow the acceptance of this technology. We assess the perioperative complication rate with minimally invasive single- and two-level interbody fusions and compare this incidence with a contemporaneous cohort of open single- and two-level open interbody fusions, with all procedures completed by a single surgeon in a single practice group. We compiled all open and MIS interbody fusion cases completed during the study period. Sofamor-Danek X-Tube™ and Stryker Luxor™ minimally invasive systems were used on all patients. Medical records were reviewed to assess any adverse events occurring in the perioperative period. Care was taken to include all medical and surgical adverse events and complications occurring within 30 days of surgery. Over the study period, 28 minimally invasive lumbar fusions were identified: 24 single- and 4 two-level cases. Both TLIF and PLIF techniques were used. This cohort was compared with a group of 19 single- and two-level open interbody fusion cases completed over the same period. The complication rate for the MIS cohort was 18%, with 7 complications occurring in 5 patients. In the open group, 8 complications occurred in 7 patients, an incidence of 37%. A standard distribution of complications occurred, and the difference between the two groups was not statistically significant. Limiting our analysis to severe complications yielded rates of 7% and 21% for the two groups, also not significantly divergent. Perioperative complications are not more common in well-selected MIS patients. Allowing for proper patient selection, MIS techniques have a favorable complication profile.

Authors:

Bradley Bagan, M.D., Resident, Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois, Nimesh Patel, M.D. Resident, Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois, Harel Deutsch, M.D., Assistant Professor, Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois, James Harrop, M.D., Assistant Professor, Department of Neurosurgery, Thomas Jefferson University Medical Center, Philadelphia, Pennsylvania, Ashwini Sharan, M.D., Assistant Professor, Department of Neurosurgery, Thomas Jefferson University Medical Center, Philadelphia, Pennsylvania, Alexander R. Vaccaro, M.D., Professor, Department of Orthopedic Surgery, Thomas Jefferson University Medical Center, Philadelphia, Pennsylvania, John K. Ratliff, M.D., Assistant Professor, Department of Neurosurgery, Rush University Medical Center, and Chicago, Illinois, Department of Neurosurgery, Thomas Jefferson University Medical Center, Philadelphia, Pennsylvania

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