Instrumentation related complication of lumbar degenerative disc diseases treated by minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF)

Abstract

Objective To analyze the instrumentation-related complications of lumbar degenerative disc disease (LDD) patients who underwent minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) procedure and discussion the potential strategy to control these complications. Methods 87 patients (29 males, 58 females; mean age: 54.2 years) with LDD were included in this study. All patients underwent MIS-TLIF procedure, among which 68 cases received single-level and 19 patients received two-level surgery. The affected levels were L3-4 in 21 cases, L4-5 in 57, and L5-S1 in 28 cases. The preoperative diagnosis was lumbar spondylolisthesis (40 of Meyerding grade I and 2 of grade II spondylolisthesis) in 42 cases, lumbar spinal stenosis (LSS) in 26, LSS with instability in 12 cases, and lumbar surgery revision in 7. A total of 386 percutaneous pedicel screws (PPS) were included in this series. The complications including malposition or breakage of guide pin, PPS or cages, neurological deficit, and superior level facet joint violations were determined during and after the surgery. Computed tomography (CT) was used to evaluate the accuracy of PPS and superior level facet joint violations. Results During surgery, guide pin and PPS perforated anterior wall of vertebral body in 3 cases and 1 case, respectively. 1 PPS (0.3%) was pulled out during the reduction of slip because of severe osteoporosis. Malposition of cages occurred in 6 cases. All these were adjusted accordingly during surgery. All cases received more than 2 years follow-up. CT showed 27 misplaced PPS, including 20 grade 1 screws, 4 grade 2 screws, 2 (0.5%) grade 3 screws, and 1 grade 4 screw. Misplaced PPSs were located at L4 (13 screws), L5 (9 screws) and S1 (5 screws). 1 grade 4 screw (0.3%) resulted in unilateral low back pain. The total FJV rate was 36.2%, with Grade 2 and 3 violation occurred in 21 (12.1%) and 3 cases (3.4%), respectively. The highest occurrence of FJV occurred in L5 in this series. Conclusion MIS-TLIF has similar instrumentation-related complications with open TLIF. Accurate pre-operative evaluation and improvement in surgical technique can effectively reduce instrumentation-related complications. Key words: Lumbar vertebrae; Surgical procedures, minimally invasive; Vertebroplasty; Internal fixators