Nationwide Survey of the Surgical Complications Associated with Lateral Lumbar Interbody Fusion in 2015-2020

Mitsuru Yagi; Nobuyuki Fujita; Tomohiko Hasegawa; Gen Inoue; Yoshihisa Kotani; Seiji Ohtori; Sumihisa Orita; Yasushi Oshima; Daisuke Sakai; Toshinori Sakai; Hiroshi Taneichi; Daisuke Togawa; Kazuo Nakanishi; Hiroaki Nakashima; Toshitaka Yoshii; Masaya Nakamura; Motoki Iwasaki; Masahiko Watanabe; Hirotaka Haro; Tokumi Kanemura; Naobumi Hosogane; New Technology Assessment Committee of The Japanese Society for Spine Surgery and Related Research

doi:10.22603/ssrr.2022-0194

Nationwide Survey of the Surgical Complications Associated with Lateral Lumbar Interbody Fusion in 2015-2020

Spine Surg Relat Res. 2022 Dec 12;7(3):249-256. doi: 10.22603/ssrr.2022-0194. eCollection 2023 May 27.

Authors

Mitsuru Yagi¹, Nobuyuki Fujita², Tomohiko Hasegawa³, Gen Inoue⁴, Yoshihisa Kotani⁵, Seiji Ohtori⁶, Sumihisa Orita^{6

7}, Yasushi Oshima⁸, Daisuke Sakai⁹, Toshinori Sakai¹⁰, Hiroshi Taneichi¹¹, Daisuke Togawa¹², Kazuo Nakanishi¹³, Hiroaki Nakashima¹⁴, Toshitaka Yoshii¹⁵, Masaya Nakamura¹, Motoki Iwasaki¹⁶, Masahiko Watanabe⁹, Hirotaka Haro¹⁷, Tokumi Kanemura¹⁸, Naobumi Hosogane¹⁹; New Technology Assessment Committee of The Japanese Society for Spine Surgery and Related Research

Affiliations

¹ Department of Orthopedic Surgery, Keio University, School of Medicine, Tokyo, Japan.
² Department of Orthopedic Surgery, Fujita Health University, Toyoake, Japan.
³ Department of Orthopedic Surgery, Hamamatsu University, School of Medicine, Hamamatsu, Japan.
⁴ Department of Orthopaedic Surgery, Kitasato University School of Medicine, Sagamihara, Japan.
⁵ Department of Orthopaedic Surgery, Kansai Medical University Medical Center, Moriguchi, Japan.
⁶ Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan.
⁷ Center for Frontier Medical Engineering, Chiba University, Chiba, Japan.
⁸ Department of Orthopaedic Surgery and Spinal Surgery, The University of Tokyo, Tokyo, Japan.
⁹ Department of Orthopedic Surgery, Tokai University School of Medicine, Isehara, Japan.
¹⁰ Department of Orthopedics, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan.
¹¹ Department of Orthopedic Surgery, Dokkyo Medical University, Mibu, Japan.
¹² Department of Orthopedic Surgery, Kinki University, Nara Hospital, Ikoma, Japan.
¹³ Department of Orthopedics, Traumatology and Spine Surgery, Kawasaki Medical School, Kurashiki, Japan.
¹⁴ Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
¹⁵ Department of Orthopedic Surgery, Graduate School, Tokyo Medical and Dental University, Tokyo, Japan.
¹⁶ Department of Orthopedic Surgery, Osaka Rosai Hospital, Sakai, Japan.
¹⁷ Department of Orthopaedic Surgery, Graduate School of Medicine, University of Yamanashi, Chuo, Japan.
¹⁸ Department of Orthopedic Surgery, Konan Kosei Hospital, Konan, Japan.
¹⁹ Department of Orthopedic Surgery, Kyorin University, School of Medicine, Tokyo, Japan.

Abstract

Introduction: Lateral lumbar interbody fusion (LLIF) has been introduced in Japan in 2013. Despite the effectiveness of this procedure, several considerable complications have been reported. This study reported the results of a nationwide survey performed by the Japanese Society for Spine Surgery and Related Research (JSSR) on the complications associated with LLIF performed in Japan.

Methods: JSSR members conducted a web-based survey following LLIF between 2015 and 2020. Any complications meeting the following criteria were included: (1) major vessel, (2) urinary tract, (3) renal, (4) visceral organ, (5) lung, (6) vertebral, (7) nerve, and (8) anterior longitudinal ligament injury; (9) weakness of psoas; (10) motor and (11) sensory deficit; (12) surgical site infection; and (13) other complications. The complications were analyzed in all LLIF patients, and the differences in incidence and type of complications between the transpsoas (TP) and prepsoas (PP) approaches were compared.

Results: Among the 13,245 LLIF patients (TP 6,198 patients [47%] and PP 7,047 patients [53%]), 389 complications occurred in 366 (2.76%) patients. The most common complication was sensory deficit (0.5%), followed by motor deficit (0.43%) and weakness of psoas muscle (0.22%). Among the patient cohort, 100 patients (0.74%) required revision surgery during the survey period. Almost half of the complications developed in patients with spinal deformity (183 patients [47.0%]). Four patients (0.03%) died from complications. Statistically more frequent complications occurred in the TP approach than in the PP approach (TP vs. PP, 220 patients [3.55%] vs. 169 patients [2.40%]; p<0.001).

Conclusions: The overall complication rate was 2.76%, and 0.74% of the patients required revision surgery because of complications. Four patients died from complications. LLIF may be beneficial for degenerative lumbar conditions with acceptable complications; however, the indication for spinal deformity should be carefully determined by the experience of the surgeon and the extent of the deformity.

Keywords: Degenerative spine conditions; LLIF; complications; major vessel injury; nationwide survey.