title: Vertebral body fracture following stand-alone lateral lumbar interbody fusion (LLIF): report of two events out of 712 levels.
abstract: OBJECTIVE
  Available studies demonstrate vertebral body fractures as a relatively rare complication following lateral lumbar interbody fusion (LLIF), with most fractures reported in association with lateral plating and vertebral screws. This study reports the occurrence of two vertebral body fractures following stand-alone LLIF in 712 levels fused in 335 patients.
  
  
  METHODS
  A retrospective review of prospectively collected data was performed on all patients who underwent minimally invasive LLIF over a seven-year period at a single institution. Patients with vertebral body fractures were recorded.
  
  
  RESULTS
  Two patients (0.6 %) out of 335 total patients (712 levels) were identified with vertebral body fractures following stand-alone LLIF. Both patients presented with severe back pain and return of symptoms within 2 weeks of the index surgery. Both patients were obese, had impaired bone mineral density and were managed with open posterior segmental fixation.
  
  
  CONCLUSIONS
  The 0.6 % incidence of vertebral body fractures in our series of fusing 712 levels is in accordance with the incidence rates reported in the literature. Potential risk factors for vertebral body fractures at the index LLIF level included obesity, osteopenia, unrecognized intraoperative endplate breach, graft subsidence and oversized graft placement.
authors.affiliation: Department of Neurological Surgery, University of Pittsburgh Medical Center, 200 Lothrop Street, Suite B400, Pittsburgh, PA, 15213, USA, tempelzj@upmc.edu.
authors.forename: Zachary J
authors.initials: ZJ
authors.lastname: Tempel
authors.forename: Gurpreet S
authors.initials: GS
authors.lastname: Gandhoke
authors.forename: Bryan D
authors.initials: BD
authors.lastname: Bolinger
authors.forename: David O
authors.initials: DO
authors.lastname: Okonkwo
authors.forename: Adam S
authors.initials: AS
authors.lastname: Kanter
mesh_terms: D000328:Adult; D000368:Aged; D015519:Bone Density / Q000502:physiology; D001851:Bone Diseases, Metabolic / Q000150:complications; D016025:Bone Transplantation / Q000009:adverse effects; D005260:Female; D006801:Humans; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects / Q000379:methods; D009765:Obesity / Q000150:complications; D012189:Retrospective Studies; D016103:Spinal Fractures / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D013123:Spinal Fusion / Q000009:adverse effects*; D014057:Tomography, X-Ray Computed