Minimally invasive interbody fusion for revision lumbar surgery: technical feasibility and safety.
METHODS
Retrospective chart review of one surgeon's practice.


OBJECTIVE
We evaluate the perioperative morbidity of 43 patients undergoing minimally invasive lumbar interbody fusion to differentiate risks between primary and revision surgery candidates.


BACKGROUND
Minimally invasive approaches to the lumbar spine have rapidly evolved and the technical feasibility and safety of minimally invasive interbody fusion is well established. Revision surgery is technically more challenging and may cause avoidance of such approaches because of altered anatomy and absent bony landmarks. Description of minimally invasive surgery approaches among revision patients and the feasibility of such techniques demands clarification.


METHODS
Forty-three consecutive minimally invasive transforaminal lumbar interbody fusions (TLIFs) and posterior lumbar interbody fusions (PLIFs) were reviewed. Estimated blood loss, operative time, and complication rates were compared between primary and revision patients using Student t tests.


RESULTS
Seventeen revision surgery cases (40%) were compared with 26 primary surgeries (60%) to elucidate differences in operative time, estimated blood loss, and complications. Demographic variables were similar in both groups. Estimated blood loss trended higher among the PLIF group and among revision cases, though no statistical significance was observed. A higher rate of complications, most notably incidental durotomy, was observed among revision cases in both PLIF and TLIF patients. One patient undergoing primary surgery had an intraoperative pedicle fracture, and 1 patient undergoing revision surgery had an asymptomatic screw malposition. No patients had a major complication, nerve injury, infection, or conversion to an open procedure.


CONCLUSIONS
Minimally invasive lumbar interbody fusion by revision surgery is technically feasible and is not associated with more blood loss or neurologic morbidity. However, revision surgery has a higher minor perioperative complication rate, particularly of incidental durotomy. These outcomes demand significant experience before attempting minimally invasive revision surgery in the lumbar spine.
Division of Neurosurgery, Duke University Medical Center, Durham, NC 27710, USA.
Lee A
LA
Selznick
Mohammed F
MF
Shamji
Robert E
RE
Isaacs
D001863:Bone Screws / Q000009:adverse effects; D004388:Dura Mater / Q000293:injuries; D055111:Failed Back Surgery Syndrome / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D007049:Iatrogenic Disease / Q000517:prevention & control; D007431:Intraoperative Complications / Q000401:mortality; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects* / Q000379:methods / Q000401:mortality*; D011183:Postoperative Complications / Q000401:mortality; D019106:Postoperative Hemorrhage / Q000401:mortality; D011446:Prospective Studies; D011859:Radiography; D012086:Reoperation / Q000009:adverse effects / Q000379:methods / Q000401:mortality; D012189:Retrospective Studies; D016103:Spinal Fractures / Q000209:etiology / Q000401:mortality; D013123:Spinal Fusion / Q000009:adverse effects* / Q000379:methods / Q000401:mortality*