Perioperative complications in transforaminal lumbar interbody fusion versus anterior-posterior reconstruction for lumbar disc degeneration and instability.
OBJECTIVE
Multiple different approaches are used to treat lumbar degenerative disc disease and spinal instability. Both anterior-posterior (AP) reconstructive surgery and transforaminal lumbar interbody fusion (TLIF) provide a circumferential fusion and are considered reasonable surgical options. The purpose of this study was to quantitatively assess clinical parameters such as surgical blood loss, duration of the procedure, length of hospitalization, and complications for TLIF and AP reconstructive surgery for lumbar fusion.


METHODS
A retrospective analysis was completed on 167 consecutive cases performed between January 2002 and March 2004. TLIF surgical procedure was performed on 124 patients, including 73 minimally invasive and 51 open cases. AP surgery was performed on 43 patients. Patients were treated for painful degenerative disc disease, facet arthropathy, degenerative instability, and spinal stenosis.


RESULTS
The mean operative time for AP reconstruction was 455 minutes, for minimally invasive TLIF 255 minutes, and open TLIF 222 minutes. The mean blood loss for AP fusion surgery was 550 mL, for minimally invasive TLIF 231 mL, and open TLIF 424 mL. The mean hospitalization time for AP reconstruction was 7.2 days, for minimally invasive TLIF 3.1 days, and open TLIF 4.1 days. The total rate of complications was 76.7% for AP reconstruction, including 62.8% major and 13.9% minor complications. The minimally invasive TLIF patients group had the total 30.1% rate of complications, 21.9% of which were minor and 8.2% major complications. There were no major complications in the open TLIF patients group, with 35.3% minor complications.


CONCLUSIONS
AP lumbar interbody fusion surgery is associated with a more than two times higher complication rate, significantly increased blood loss, and longer operative and hospitalization times than both percutaneous and open TLIF for lumbar disc degeneration and instability.
Villavicencio
Alan T
AT
Boulder Neurosurgical Associates, CO 80304, USA. atv@bnasurg.com
Burneikiene
Sigita
S
Bulsara
Ketan R
KR
Thramann
Jeffrey J
JJ
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003120:Colorado / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D007405:Intervertebral Disc Displacement / Q000453:epidemiology / Q000601:surgery*; D007593:Joint Instability / Q000453:epidemiology* / Q000517:prevention & control*; D008159:Lumbar Vertebrae / Q000601:surgery; D008875:Middle Aged; D019990:Perioperative Care / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000453:epidemiology*; D019651:Plastic Surgery Procedures / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D013123:Spinal Fusion / Q000706:statistics & numerical data*; D016896:Treatment Outcome