{"id":"4d6c7006-36ba-46c6-8654-4f3d381226a0","slug":"non-neurological-major-complications-of-extreme-lateral-and-related-lumbar-interbody-fusion-techniques","title":"Non-neurological major complications of extreme lateral and related lumbar interbody fusion techniques","authors":["Nancy E. Epstein"],"abstract":"Background: Complications exclusive of new neurological deficits/injuries that follow extreme lateral interbody fusion (XLIF) and related lateral lumbar interbody techniques should be better recognized to determine the safety of these procedures. Unfortunately, a review of the XLIF literature did not accurately reflect the frequency of these “other complications” as few US surgeons publish such adverse events that may lead to medicolegal suits. Methods: Major complications occurring with XLIF included sympathectomy, major vascular injuries, bowel perforations, sterile seromas, and instrumentation failures. Results: The frequency of sympathectomy was 4% for XLIF vs. 15% for anterior lumbar interbody fusion (ALIF). There were three major vascular injuries for XLIF; one fatal intraoperative event, one life-threatening retroperitoneal hematoma, and one iatrogenic lumbar artery pseudoaneurysm that was successfully embolized. Two bowel perforations were reported, whereas a third was a “direct communication.” One patient developed a sterile recurrent seroma due to vancomycin powder utilized for an XLIF. One study cited malpositioning of an XLIF cage resulting in a lateral L3–L4 extrusion, whereas the second series looked at the 45% risk of cage-overhang when XLIF devices were placed in the anterior one-third of the vertebral body. Conclusion: Excluding new neurological deficits, XLIF techniques resulted in multiple other major complications. However, these small numbers likely reflect just the tip of the iceberg (e.g., 10%) and the remaining 90% may never be known as many US-based spine surgeons fail to publish such adverse events as they are discoverable in a court of law and may lead to medicolegal suits.","thumbnailUrl":"https://sni-digital-videos.s3.amazonaws.com/articles/4d6c7006-36ba-46c6-8654-4f3d381226a0/featured/hero-1782420908637.png","publishDate":"2016-09-22T00:00:00.000Z","doi":"10.4103/2152-7806.191071","categories":["Spine","Original Article"],"fullTextUrl":"https://surgicalneurologyint.com/api/articles/4d6c7006-36ba-46c6-8654-4f3d381226a0/pdf"}