Complications of Lateral Lumbar Interbody Fusion (XLIF). Narrative Literature Review
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Published:
Feb 15, 2024
Keywords:
Lateral lumbar arthrodesis, spine surgery, complications, XLIF, LLIF, lateral approach to the lumbar spine
Main Article Content
Abstract
Introduction: The lateral approach for lumbar interbody fusion has been described for the treatment of diverse pathologies. Although it is a safe procedure, its popularity has led to an increase in reports of complications associated with it. The objective of this work is to conduct a narrative review of the literature on the most frequently reported complications associated with this surgical approach.
Materials and Methods: We performed a narrative review of the literature based on the publications obtained from the following databases: PubMed.gov, Web of Science, Scopus and Lilacs to identify published articles that detail complications related to the lateral approach to the lumbar spine.
Results: After analyzing the results of the bibliographic search, 18 articles were selected to carry out this review.
Conclusions: The most frequent complications directly related to this approach are thigh pain and motor deficit for hip flexion and/or leg extension, which are mostly temporary and reversible. Severe or fatal vascular injuries have rarely been reported.
Materials and Methods: We performed a narrative review of the literature based on the publications obtained from the following databases: PubMed.gov, Web of Science, Scopus and Lilacs to identify published articles that detail complications related to the lateral approach to the lumbar spine.
Results: After analyzing the results of the bibliographic search, 18 articles were selected to carry out this review.
Conclusions: The most frequent complications directly related to this approach are thigh pain and motor deficit for hip flexion and/or leg extension, which are mostly temporary and reversible. Severe or fatal vascular injuries have rarely been reported.
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How to Cite
Pereira Duarte, M. (2024). Complications of Lateral Lumbar Interbody Fusion (XLIF). Narrative Literature Review. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 89(1), 76-82. https://doi.org/10.15417/issn.1852-7434.2024.89.1.1861
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Review article
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References
1. Ozgur BM, Aryan HE, Pimenta L, Taylor WR. Extreme lateral interbody fusion (XLIF): a novel surgical technique
for anterior lumbar interbody fusion. Spine J 2006;6:435-43. https://doi.org/10.1016/j.spinee.2005.08.012
2. Pereira Duarte M, Petracchi MG, Mereles ME, Gruenberg M, Solá CA, Girardi FP. Artrodesis intersomática lateral
de columna lumbar: Técnica quirúrgica y conceptos actuales [Lateral lumbar interbody fusion. Surgical technique
and current concepts]. Rev Asoc Argent Ortop Traumatol 2018;83(4):303-16. https://doi.org/10.15417/issn.1852-7434.2018.83.4.754
3. Rodgers WB, Gerber EJ, Patterson J. Intraoperative and early postoperative complications in extreme lateral
interbody fusion: an analysis of 600 cases. Spine (Phila Pa 1976) 2011;36(1):26-32. https://doi.org/10.1097/BRS.0b013e3181e1040a
4. Fontes RB, Traynelis VC. Transpsoas approach and complications. J Neurosurg Spine 2011;15(1):9-10; author reply p. 10. https://doi.org/10.3171/2010.12.SPINE10741
5. Ahmadian A, Deukmedjian AR, Abel N, Dakwar E, Uribe JS. Analysis of lumbar plexopathies and nerve injury
after lateral retroperitoneal transpsoas approach: diagnostic standardization. J Neurosurg Spine 2013;18(3):289-97. https://doi.org/10.3171/2012.11.SPINE12755
6. Moller DJ, Slimack NP, Acosta FL Jr, Koski TR, Fessler RG, Liu JC. Minimally invasive lateral lumbar interbody
fusion and transpsoas approach-related morbidity. Neurosurg Focus 2011;31(4):E4. https://doi.org/10.3171/2011.7.FOCUS11137
7. Cummock MD, Vanni S, Levi AD, Yu Y, Wang MY. An analysis of postoperative thigh symptoms after minimally
invasive transpsoas lumbar interbody fusion. J Neurosurg Spine 2011;15:11-8. https://doi.org/10.3171/2011.2.SPINE10374
8. Pumberger M, Hughes AP, Huang RR, Sama AA, Cammisa FP, Girardi FP. Neurologic deficit following lateral
lumbar interbody fusion. Eur Spine J 2012;21:1192-9. https://doi.org/10.1007/s00586-011-2087-9
9. Isaacs RE, Hyde J, Goodrich JA, Rodgers WB, Phillips FM. A prospective, nonrandomized, multicenter evaluation
of extreme lateral interbody fusion for the treatment of adult degenerative scoliosis: perioperative outcomes and
complications. Spine (Phila Pa 1976) 2010;35(26 Suppl):S322-30. https://doi.org/10.1097/BRS.0b013e3182022e04
10. Lykissas MG, Aichmair A, Hughes AP, Sama AA, Lebl DR, Taher F, et al. Nerve injury after lateral lumbar
interbody fusion: a review of 919 treated levels with identification of risk factors. Spine J 2014;14(5):749-58.
https://doi.org/10.1016/j.spinee.2013.06.066
11. Dakwar E, Le TV, Baaj AA, Smith WD, Akbarnia BA, Uribe JS. Abdominal wall paresis as a complication of
minimally invasive lateral transpsoas interbody fusion. Neurosurg Focus 2011;31(4):E18. https://doi.org/10.3171/2011.7.FOCUS11164
12. Karikari IO, Grossi PM, Nimjee SM, Hardin C, Hodges TR, Hughes BD, et al. Minimally invasive lumbar interbody fusion in patients older than 70 years of age: analysis of peri- and postoperative complications. Neurosurgery 2011;68(4):897-902. https://doi.org/10.1227/NEU.0b013e3182098bfa
13. Dua K, Kepler CK, Huang RC, Marchenko A. Vertebral body fracture after anterolateral instrumentation and
interbody fusion in two osteoporotic patients. Spine J 2010;10(9):e11-5. https://doi.org/10.1016/j.spinee.2010.07.007
14. Brier-Jones JE, Palmer DK, Inceoglu S, Cheng WK. Vertebral body fractures after transpsoas interbody fusion
procedures. Spine J 2011;11(11):1068-72. https://doi.org/10.1016/j.spinee.2011.07.020
15. Essig DA, Cho W, Hughes AP, Huang RC, Sama AA, Girardi FP, et al. Risk factors for implant subsidence after
stand-alone lateral interbody fusion. Spine J 2014;14(11 Suppl):S114. https://doi.org/10.1016/j.spinee.2014.08.284
16. Rodgers WB, Cox CS, Gerber EJ. Early complications of extreme lateral interbody fusion in the obese. J Spinal
Disord Tech 2010;23(6):393-7. https://doi.org/10.1097/BSD.0b013e3181b31729
17. Assina R, Majmundar NJ, Herschman Y, Heary RF. First report of major vascular injury due to lateral transpsoas approach leading to fatality. J Neurosurg Spine 2014;21(5):794-8. https://doi.org/10.3171/2014.7.SPINE131146.
18. Buric J, Bombardieri D. Direct lesion and repair of a common iliac vein during XLIF approach. Eur Spine J
2016;25 (Suppl 1):89-93. https://doi.org/10.1007/s00586-015-4134-4
19. Epstein NE. Review of risks and complications of extreme lateral interbody fusion (XLIF). Surg Neurol Int
2019;10:237. https://doi.org/10.25259/SNI_559_2019
20. Fujibayashi S, Kawakami N, Asazuma T, Ito M, Mizutani J, Nagashima H, et al. Complications associated with
lateral interbody fusion: Nationwide survey of 2998 cases during the first 2 years of its use in Japan. Spine (Phila Pa 1976) 2017;42(19):1478-84. https://doi.org/10.1097/BRS.0000000000002139
21. Quinn JC, Fruauff K, Lebl DR, Giambrone A, Cammisa FP, Gupta A, et al. Magnetic resonance neurography of the lumbar plexus at the L4-L5 disc: development of a preoperative surgical planning tool for lateral lumbar transpsoas interbody fusion (LLIF). Spine (Phila Pa 1976) 2015;40(12):942-7. https://doi.org/10.1097/BRS.0000000000000899
22. Guerin P, Obeid I, Bourghli A, Masquefa T, Luc S, Gille O, et al. The lumbosacral plexus: anatomic considerations for minimally invasive retroperitoneal transpsoas approach. Surg Radiol Anat 2012;34(2):151-7.
https://doi.org/10.1007/s00276-011-0881-z
23. Kepler CK, Bogner EA, Herzog RJ, Huang RC. Anatomy of the psoas muscle and lumbar plexus with respect to
the surgical approach for lateral transpsoas interbody fusion. Eur Spine J 2011;20(4):550-6.
https://doi.org/10.1007/s00586-010-1593-5
24. Kotwal S, Kawaguchi S, Lebl D, Hughes A, Huang R, Sama A, et al. Minimally invasive lateral lumbar interbody
fusion: clinical and radiographic outcome at a minimum 2-year follow-up. J Spinal Disord Tech 2015;28(4):119-25.
https://doi.org/10.1097/BSD.0b013e3182706ce7
25. Sharma AK, Kepler CK, Girardi FP, Cammisa FP, Huang RC, Sama AA. Lateral lumbar interbody fusion: clinical
and radiographic outcomes at 1 year: a preliminary report. J Spinal Disord Tech 2011;24(4):242-50.
https://doi.org/10.1097/BSD.0b013e3181ecf995
26. Spivak JM, Paulino CB, Patel A, Shanti N, Pathare N. Safe zone for retractor placement to the lumbar spine via the transpsoas approach. J Orthop Surg (Hong Kong) 2013;21(1):77-81. https://doi.org/10.1177/230949901302100120
27. Uribe JS, Isaacs RE, Youssef JA, Khajavi K, Balzer JR, Kanter AS, et al. Can triggered electromyography
monitoring throughout retraction predict postoperative symptomatic neuropraxia after XLIF? Results from a
prospective multicenter trial. Eur Spine J 2015;24(Suppl 3):378-85. https://doi.org/10.1007/s00586-015-3871-8
28. Berjano P, Gautschi OP, Schils F, Tessitore E. Extreme lateral interbody fusion (XLIF®): how I do it. Acta
Neurochir (Wien) 2015;157(3):547-51. https://doi.org/10.1007/s00701-014-2248-9
29. Mundis GM, Akbarnia BA, Phillips FM. Adult deformity correction through minimally invasive lateral approach
techniques. Spine (Phila Pa 1976) 2010;35(26 Suppl):S312-21. https://doi.org/10.1097/BRS.0b013e318202495f
30. Youssef JA, McAfee PC, Patty CA, Raley E, DeBauche S, Shucosky E, et al. Minimally invasive surgery: lateral
approach interbody fusion: results and review. Spine (Phila Pa 1976) 2010;35(26 Suppl):S302-11.
https://doi.org/10.1097/BRS.0b013e3182023438
31. Pawar A, Hughes A, Girardi F, Sama A, Lebl D, Cammisa F. Lateral lumbar interbody fusion. Asian Spine J
2015;9(6):978-83. https://doi.org/10.4184/asj.2015.9.6.978
32. Deukmedjian AR, Dakwar E, Ahmadian A, Smith DA, Uribe JS. Early outcomes of minimally invasive anterior
longitudinal ligament release for correction of sagittal imbalance in patients with adult spinal deformity. Scientific World J 2012;2012:789698. https://doi.org/10.1100/2012/789698
33. Walker CT, Farber SH, Cole TS, Xu DS, Godzik J, Whiting AC, et al. Complications for minimally invasive lateral
interbody arthrodesis: a systematic review and meta-analysis comparing prepsoas and transpsoas approaches. J
Neurosurg Spine 2019;25:1-15. https://doi.org/10.3171/2018.9.SPINE18800
34. Alonso F, Graham R, Rustagi T, Drazin D, Loukas M, Oskouian RJ, et al. The subcostal nerve during lateral
approaches to the lumbar spine: An anatomical study with relevance for injury avoidance and postoperative
complications such as abdominal wall hernia. World Neurosurg 2017;104:669-73. https://doi.org/10.1016/j.wneu.2017.05.055
for anterior lumbar interbody fusion. Spine J 2006;6:435-43. https://doi.org/10.1016/j.spinee.2005.08.012
2. Pereira Duarte M, Petracchi MG, Mereles ME, Gruenberg M, Solá CA, Girardi FP. Artrodesis intersomática lateral
de columna lumbar: Técnica quirúrgica y conceptos actuales [Lateral lumbar interbody fusion. Surgical technique
and current concepts]. Rev Asoc Argent Ortop Traumatol 2018;83(4):303-16. https://doi.org/10.15417/issn.1852-7434.2018.83.4.754
3. Rodgers WB, Gerber EJ, Patterson J. Intraoperative and early postoperative complications in extreme lateral
interbody fusion: an analysis of 600 cases. Spine (Phila Pa 1976) 2011;36(1):26-32. https://doi.org/10.1097/BRS.0b013e3181e1040a
4. Fontes RB, Traynelis VC. Transpsoas approach and complications. J Neurosurg Spine 2011;15(1):9-10; author reply p. 10. https://doi.org/10.3171/2010.12.SPINE10741
5. Ahmadian A, Deukmedjian AR, Abel N, Dakwar E, Uribe JS. Analysis of lumbar plexopathies and nerve injury
after lateral retroperitoneal transpsoas approach: diagnostic standardization. J Neurosurg Spine 2013;18(3):289-97. https://doi.org/10.3171/2012.11.SPINE12755
6. Moller DJ, Slimack NP, Acosta FL Jr, Koski TR, Fessler RG, Liu JC. Minimally invasive lateral lumbar interbody
fusion and transpsoas approach-related morbidity. Neurosurg Focus 2011;31(4):E4. https://doi.org/10.3171/2011.7.FOCUS11137
7. Cummock MD, Vanni S, Levi AD, Yu Y, Wang MY. An analysis of postoperative thigh symptoms after minimally
invasive transpsoas lumbar interbody fusion. J Neurosurg Spine 2011;15:11-8. https://doi.org/10.3171/2011.2.SPINE10374
8. Pumberger M, Hughes AP, Huang RR, Sama AA, Cammisa FP, Girardi FP. Neurologic deficit following lateral
lumbar interbody fusion. Eur Spine J 2012;21:1192-9. https://doi.org/10.1007/s00586-011-2087-9
9. Isaacs RE, Hyde J, Goodrich JA, Rodgers WB, Phillips FM. A prospective, nonrandomized, multicenter evaluation
of extreme lateral interbody fusion for the treatment of adult degenerative scoliosis: perioperative outcomes and
complications. Spine (Phila Pa 1976) 2010;35(26 Suppl):S322-30. https://doi.org/10.1097/BRS.0b013e3182022e04
10. Lykissas MG, Aichmair A, Hughes AP, Sama AA, Lebl DR, Taher F, et al. Nerve injury after lateral lumbar
interbody fusion: a review of 919 treated levels with identification of risk factors. Spine J 2014;14(5):749-58.
https://doi.org/10.1016/j.spinee.2013.06.066
11. Dakwar E, Le TV, Baaj AA, Smith WD, Akbarnia BA, Uribe JS. Abdominal wall paresis as a complication of
minimally invasive lateral transpsoas interbody fusion. Neurosurg Focus 2011;31(4):E18. https://doi.org/10.3171/2011.7.FOCUS11164
12. Karikari IO, Grossi PM, Nimjee SM, Hardin C, Hodges TR, Hughes BD, et al. Minimally invasive lumbar interbody fusion in patients older than 70 years of age: analysis of peri- and postoperative complications. Neurosurgery 2011;68(4):897-902. https://doi.org/10.1227/NEU.0b013e3182098bfa
13. Dua K, Kepler CK, Huang RC, Marchenko A. Vertebral body fracture after anterolateral instrumentation and
interbody fusion in two osteoporotic patients. Spine J 2010;10(9):e11-5. https://doi.org/10.1016/j.spinee.2010.07.007
14. Brier-Jones JE, Palmer DK, Inceoglu S, Cheng WK. Vertebral body fractures after transpsoas interbody fusion
procedures. Spine J 2011;11(11):1068-72. https://doi.org/10.1016/j.spinee.2011.07.020
15. Essig DA, Cho W, Hughes AP, Huang RC, Sama AA, Girardi FP, et al. Risk factors for implant subsidence after
stand-alone lateral interbody fusion. Spine J 2014;14(11 Suppl):S114. https://doi.org/10.1016/j.spinee.2014.08.284
16. Rodgers WB, Cox CS, Gerber EJ. Early complications of extreme lateral interbody fusion in the obese. J Spinal
Disord Tech 2010;23(6):393-7. https://doi.org/10.1097/BSD.0b013e3181b31729
17. Assina R, Majmundar NJ, Herschman Y, Heary RF. First report of major vascular injury due to lateral transpsoas approach leading to fatality. J Neurosurg Spine 2014;21(5):794-8. https://doi.org/10.3171/2014.7.SPINE131146.
18. Buric J, Bombardieri D. Direct lesion and repair of a common iliac vein during XLIF approach. Eur Spine J
2016;25 (Suppl 1):89-93. https://doi.org/10.1007/s00586-015-4134-4
19. Epstein NE. Review of risks and complications of extreme lateral interbody fusion (XLIF). Surg Neurol Int
2019;10:237. https://doi.org/10.25259/SNI_559_2019
20. Fujibayashi S, Kawakami N, Asazuma T, Ito M, Mizutani J, Nagashima H, et al. Complications associated with
lateral interbody fusion: Nationwide survey of 2998 cases during the first 2 years of its use in Japan. Spine (Phila Pa 1976) 2017;42(19):1478-84. https://doi.org/10.1097/BRS.0000000000002139
21. Quinn JC, Fruauff K, Lebl DR, Giambrone A, Cammisa FP, Gupta A, et al. Magnetic resonance neurography of the lumbar plexus at the L4-L5 disc: development of a preoperative surgical planning tool for lateral lumbar transpsoas interbody fusion (LLIF). Spine (Phila Pa 1976) 2015;40(12):942-7. https://doi.org/10.1097/BRS.0000000000000899
22. Guerin P, Obeid I, Bourghli A, Masquefa T, Luc S, Gille O, et al. The lumbosacral plexus: anatomic considerations for minimally invasive retroperitoneal transpsoas approach. Surg Radiol Anat 2012;34(2):151-7.
https://doi.org/10.1007/s00276-011-0881-z
23. Kepler CK, Bogner EA, Herzog RJ, Huang RC. Anatomy of the psoas muscle and lumbar plexus with respect to
the surgical approach for lateral transpsoas interbody fusion. Eur Spine J 2011;20(4):550-6.
https://doi.org/10.1007/s00586-010-1593-5
24. Kotwal S, Kawaguchi S, Lebl D, Hughes A, Huang R, Sama A, et al. Minimally invasive lateral lumbar interbody
fusion: clinical and radiographic outcome at a minimum 2-year follow-up. J Spinal Disord Tech 2015;28(4):119-25.
https://doi.org/10.1097/BSD.0b013e3182706ce7
25. Sharma AK, Kepler CK, Girardi FP, Cammisa FP, Huang RC, Sama AA. Lateral lumbar interbody fusion: clinical
and radiographic outcomes at 1 year: a preliminary report. J Spinal Disord Tech 2011;24(4):242-50.
https://doi.org/10.1097/BSD.0b013e3181ecf995
26. Spivak JM, Paulino CB, Patel A, Shanti N, Pathare N. Safe zone for retractor placement to the lumbar spine via the transpsoas approach. J Orthop Surg (Hong Kong) 2013;21(1):77-81. https://doi.org/10.1177/230949901302100120
27. Uribe JS, Isaacs RE, Youssef JA, Khajavi K, Balzer JR, Kanter AS, et al. Can triggered electromyography
monitoring throughout retraction predict postoperative symptomatic neuropraxia after XLIF? Results from a
prospective multicenter trial. Eur Spine J 2015;24(Suppl 3):378-85. https://doi.org/10.1007/s00586-015-3871-8
28. Berjano P, Gautschi OP, Schils F, Tessitore E. Extreme lateral interbody fusion (XLIF®): how I do it. Acta
Neurochir (Wien) 2015;157(3):547-51. https://doi.org/10.1007/s00701-014-2248-9
29. Mundis GM, Akbarnia BA, Phillips FM. Adult deformity correction through minimally invasive lateral approach
techniques. Spine (Phila Pa 1976) 2010;35(26 Suppl):S312-21. https://doi.org/10.1097/BRS.0b013e318202495f
30. Youssef JA, McAfee PC, Patty CA, Raley E, DeBauche S, Shucosky E, et al. Minimally invasive surgery: lateral
approach interbody fusion: results and review. Spine (Phila Pa 1976) 2010;35(26 Suppl):S302-11.
https://doi.org/10.1097/BRS.0b013e3182023438
31. Pawar A, Hughes A, Girardi F, Sama A, Lebl D, Cammisa F. Lateral lumbar interbody fusion. Asian Spine J
2015;9(6):978-83. https://doi.org/10.4184/asj.2015.9.6.978
32. Deukmedjian AR, Dakwar E, Ahmadian A, Smith DA, Uribe JS. Early outcomes of minimally invasive anterior
longitudinal ligament release for correction of sagittal imbalance in patients with adult spinal deformity. Scientific World J 2012;2012:789698. https://doi.org/10.1100/2012/789698
33. Walker CT, Farber SH, Cole TS, Xu DS, Godzik J, Whiting AC, et al. Complications for minimally invasive lateral
interbody arthrodesis: a systematic review and meta-analysis comparing prepsoas and transpsoas approaches. J
Neurosurg Spine 2019;25:1-15. https://doi.org/10.3171/2018.9.SPINE18800
34. Alonso F, Graham R, Rustagi T, Drazin D, Loukas M, Oskouian RJ, et al. The subcostal nerve during lateral
approaches to the lumbar spine: An anatomical study with relevance for injury avoidance and postoperative
complications such as abdominal wall hernia. World Neurosurg 2017;104:669-73. https://doi.org/10.1016/j.wneu.2017.05.055