Complications and limitations of tubular retractor system in minimally invasive spine surgery: A review

Abstract

The aim of a minimally invasive spine surgery is to decrease the collateral damage to the surrounding soft tissue, while performing the same task as that of a conventional open spine surgery. With widening of applications of the tubular retractor system, complications are prone to occur while performing surgery using tubular retractors. The aim of this review was to assess the spectrum of complications that are associated with tubular access spine surgery. A systematic review in English language literature on PubMed for clinical outcomes or complications in minimally invasive spine surgery using tubular retractors was carried out. A total of 11 articles were filtered from 2010 to 2018. Articles that were excluded were those with focus on open spine surgery, surgeries without using tubular retractors, Destandau technique, and endoscopic spine surgeries. The studies were divided into discectomy, decompressions, and fusions. Overall complications that were observed in the review were incidental durotomy, neurodeficits, infection, instability, reherniation, implant malposition, pulmonary embolism, hematoma, and urinary retention. The manifold advantages that are offered by the tubular retractor system include decreased iatrogenic tissue damage, decreased probability of surgical wound infections, decreased chances of instability, and rapid ambulation of the patients, providing an impetus to the number of day care procedures being performed for spine conditions. The complication profile in this review is comparable to the open spine surgeries except the risk of higher radiation hazard in minimally invasive transforaminal lumbar interbody fusion surgery but more high-quality randomized studies are required.