title: Comparison of complication rates of minimally invasive transforaminal lumbar interbody fusion and lateral lumbar interbody fusion: a systematic review of the literature.
abstract: OBJECT Minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) and lateral lumbar interbody fusion (LLIF) are 2 currently popular techniques for lumbar arthrodesis. The authors compare the total risk of each procedure, along with other important complication outcomes. METHODS This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Relevant studies (up to May 2015) that reported complications of either MI-TLIF or LLIF were identified from a search in the PubMed database. The primary outcome was overall risk of complication per patient. Secondary outcomes included risks of sensory deficits, temporary neurological deficit, permanent neurological deficit, intraoperative complications, medical complications, wound complications, hardware failure, subsidence, and reoperation. RESULTS Fifty-four studies were included for analysis of MI-TLIF, and 42 studies were included for analysis of LLIF. Overall, there were 9714 patients (5454 in the MI-TLIF group and 4260 in the LLIF group) with 13,230 levels fused (6040 in the MI-TLIF group and 7190 in the LLIF group). A total of 1045 complications in the MI-TLIF group and 1339 complications in the LLIF group were reported. The total complication rate per patient was 19.2% in the MI-TLIF group and 31.4% in the LLIF group (p < 0.0001). The rate of sensory deficits and temporary neurological deficits, and permanent neurological deficits was 20.16%, 2.22%, and 1.01% for MI-TLIF versus 27.08%, 9.40%, and 2.46% for LLIF, respectively (p < 0.0001, p < 0.0001, p = 0.002, respectively). Rates of intraoperative and wound complications were 3.57% and 1.63% for MI-TLIF compared with 1.93% and 0.80% for LLIF, respectively (p = 0.0003 and p = 0.034, respectively). No significant differences were noted for medical complications or reoperation. CONCLUSIONS While there was a higher overall complication rate with LLIF, MI-TLIF and LLIF both have acceptable complication profiles. LLIF had higher rates of sensory as well as temporary and permanent neurological symptoms, although rates of intraoperative and wound complications were less than MI-TLIF. Larger, prospective comparative studies are needed to confirm these findings as the current literature is of relative poor quality.
authors.affiliation: Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan.
authors.forename: Jacob R
authors.initials: JR
authors.lastname: Joseph
authors.affiliation: Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan.
authors.forename: Brandon W
authors.initials: BW
authors.lastname: Smith
authors.affiliation: Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan.
authors.forename: Frank
authors.initials: F
authors.lastname: La Marca
authors.affiliation: Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan.
authors.forename: Paul
authors.initials: P
authors.lastname: Park
mesh_terms: D000818:Animals; D006801:Humans; D055959:Intervertebral Disc Degeneration / Q000601:surgery*; D007431:Intraoperative Complications / Q000209:etiology*; D008161:Lumbosacral Region / Q000601:surgery; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects*; D011183:Postoperative Complications / Q000209:etiology*; D013123:Spinal Fusion / Q000009:adverse effects*
keywords: EMG = electromyography; LLIF = lateral lumbar Interbody fusion; MI-TLIF = minimally invasive transforaminal lumbar interbody fusion; MIS = minimally invasive surgery; direct lateral interbody fusion; extreme lateral interbody fusion; lateral lumbar interbody fusion; minimally invasive spine surgery; transforaminal lumbar interbody fusion