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, nationwide survey, major vessel injury
Introduction
Degenerative lumbar spine conditions are common in the aging population and are the major cause of disability1). Degenerative lumbar spine conditions may result in low back pain, radicular pain, and neurological claudication, reduced mobility, and poor quality of life1). The surgical treatment for degenerative lumbar spine conditions often requires lumbar interbody fusion, particularly for patients with significant spinal instability, spondylolisthesis, spinal malalignment, and prior surgery2).
The surgical options for lumbar interbody fusion include posterior lumbar interbody fusion, transforaminal lumbar interbody fusion, anterior lumbar interbody fusion, and lateral lumbar interbody fusion (LLIF)2,3). LLIF with two different approaches, transpsoas and prepsoas, has been introduced in Japan since 20134). Despite the effectiveness of this procedure, several considerable complications have been reported5-8). As a feature of the surgical technique, LLIF can avoid the spinal canal, cauda equina, and nerve roots; however, it has issues with approach-related visceral and vascular complications as well as potential risks to the lumbar plexus and psoas muscle. Since 2015, the Japanese Society for Spine Surgery and Related Research (JSSR) has started a nationwide survey on the incidence and type of complications associated with LLIF among all JSSR members. The present study aimed to report the incidence and type of complications associated with LLIF performed in Japan during 2015-2020 from the results of a nationwide survey.
Materials and Methods
Data collection
This study was approved by the ethics committees of JSSR and each institution. A web-based survey on complications associated with LLIF was performed by JSSR for all JSSR members between 2015 and 2020. Questionnaires were sent to all JSSR members every July, and the data were returned by the end of February of the following year.
The questionnaire included items about patient characteristics (age, gender, and disease), type of approach (transpsoas or prepsoas), and the details of the complications. The number of patients per year and trend, type and incidence of complications, breakdown of the disease of the patients with complications, and the incidence of complications associated with the two different approaches were analyzed. To reduce data omission, preselected complications were listed in the questionnaire. Additionally, the details of the patient course, additional treatment, and final outcomes associated with the complications were collected.
Complications and unplanned reoperations
Any complications meeting the following criteria were included: (1) major vessel injury, (2) urinary tract injury, (3) renal injury, (4) bowel injury (including peritoneal injury), (5) lung injury (including pleural injury), (6) weakness of psoas muscle (exceeding 3 months[≥3 months]), (7) motor deficit (exceeds 3 months), (8) sensory deficit (exceeds 3 months), (9) vertebral injury (requires reoperation), (10) nerve injury, (11) anterior longitudinal ligament (ALL) rupture (requires reoperation), (12) surgical site infection (SSI), and (13) other complications (free text field).
Data preparation
The registered patients were categorized into two groups based on the type of approach, either the transpsoas or prepsoas approach, and then, associated with the transpsoas and prepsoas approaches was compared.
Among the complications, major vessel, ureter, renal, bowel (including peritoneal), and lung (including pleural) injuries were categorized into visceral organ complications, but weakness of psoas (≥3 months), motor deficit (≥3 months), sensory deficit (≥3 months), vertebral body injury (required reoperation), and ALL rupture (required reoperation) were categorized into perivertebral organ complications.
Statistical analysis
Differences between the transpsoas and prepsoas approach groups were compared using Pearson's chi-square and Fisher's exact tests, where appropriate. A p-value <0.05 with a confidence interval of 95% was considered statistically significant9). The Cochran-Armitage test for trend was conducted to determine whether there was a trend between the year and rate of complications and unplanned reoperations. All analyses were performed using the Statistical Package for the Social Sciences (SPSS statistics version 28.0, IBM Corp., Armonk, NY) and XLSTAT (version 2020.4, Addinsoft Inc., Paris).
Results
Number of LLIF patients per year between 2015 and 2020
There were 13,245 LLIF patients registered between 2015 and 2020. Among the registered LLIF patients, the transpsoas approach was used in 6,198 patients (46.8%), and the prepsoas approach was used in 7,047 patients (53.2%). The number of LLIF in Japan showed a significant upward trend during the study period, except in 2020, when the COVID-19 pandemic reduced the number of elective spine surgeries (p<0.001; Fig. 1)10). Additionally, the number of institutions that perform the LLIF procedure in Japan showed a significant upward trend during the study period (number of institutions; 2015-2020; 108, 121, 169, 190, 208, 230; p<0.001).
Figure 1.
Number of LLIF per year between 2015 and 2020.
The number of LLIF in Japan showed a significant upward trend, except in 2020, during the study period (p<0.001).
Incidence and type of complications in LLIF between 2015 and 2020
Three hundred eighty-nine perioperative complications occurred in 366 patients (2.76%). Among the 389 complications, 100 complications (0.74%) required revision surgery during the survey period (Table 1). The Cochran-Armitage test for trend indicated a significant downward trend for the complication rate (p<0.001; Fig. 2). The reoperation rate remained low throughout the study period (range 0.44%-1.21%; Fig. 2).
Table 1.
Incidence and Type of Complications Following Lateral Lumbar Interbody Fusion Surgery between 2015 and 2020.
| Type of complication | 2015 | 2016 | 2017 | 2018 | 2019 | 2020 | Total |
|---|---|---|---|---|---|---|---|
| Major vessel injury | 1 | 4 | 2 | 5 | 3 | 2 | 17 |
| (0.05%) | (0.26%) | (0.09%) | (0.21%) | (0.09%) | (0.11%) | (0.13%) | |
| Ureter injury | 1 | 1 | 1 | 1 | 1 | 1 | 6 |
| (0.05%) | (0.06%) | (0.04%) | (0.04%) | (0.03%) | (0.05%) | (0.05%) | |
| Renal injury | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
| Bowel injury
(peritoneal injury) |
2 | 0 | 3 | 0 | 0 | 0 | 5 |
| (0.10%) | (0.13%) | (0.04%) | |||||
| Lung injury
(pleural injury) |
3 | 0 | 2 | 1 | 5 | 3 | 14 |
| (0.15%) | (0.09%) | (0.04%) | (0.16%) | (0.16%) | (0.11%) | ||
| Weakness of psoas
(>3 months) |
5 | 6 | 6 | 5 | 3 | 4 | 29 |
| (0.25%) | (0.38%) | (0.27%) | (0.21%) | (0.09%) | (0.21%) | (0.22%) | |
| Motor deficit
(>3 months) |
15 | 7 | 9 | 8 | 9 | 9 | 57 |
| (0.75%) | (0.45%) | (0.40%) | (0.34%) | (0.28%) | (0.48%) | (0.43%) | |
| Sensory deficit
(>3 months) |
19 | 10 | 18 | 6 | 4 | 9 | 66 |
| (0.95%) | (0.64%) | (0.80%) | (0.26%) | (0.12%) | (0.48%) | (0.50%) | |
| Vertebral fracture
(required reoperation) |
5 | 1 | 6 | 4 | 2 | 3 | 21 |
| (0.25%) | (0.06%) | (0.27%) | (0.17%) | (0.06%) | (0.16%) | (0.16%) | |
| Nerve injury | 17 | 1 | 6 | 1 | 0 | 3 | 28 |
| (0.85%) | (0.06%) | (0.27%) | (0.04%) | (0.16%) | (0.21%) | ||
| Anterior longitudinal ligament rupture
(required reoperation) |
5 | 1 | 4 | 0 | 2 | 0 | 12 |
| (0.25%) | (0.06%) | (0.18%) | (0.06%) | (0.09%) | |||
| Surgical site infection | 3 | 2 | 7 | 4 | 8 | 1 | 25 |
| (0.15%) | (0.13%) | (0.13%) | (0.17%) | (0.25%) | (0.05%) | (0.19%) | |
| Miscellaneous | 38 | 14 | 17 | 24 | 12 | 4 | 109 |
| (1.91%) | (0.89%) | (0.75%) | (1.03%) | (0.37%) | (0.21%) | (0.82%) | |
| Total | 114 | 47 | 81 | 63 | 45 | 39 | 389 |
| (5.73%) | (3.00%) | (3.58%) | (2.70%) | (1.40%) | (2.07%) | (2.94%) |
Percentage in parentheses.
Figure 2.
Trend of the incidence of complications and unplanned reoperations following LLIF between 2015 and 2020.
A. Incidence trend of complications and unplanned reoperations following LLIF.
B. The incidence of neurological complications following LLIF.
C. Incidence trend of perivertebral complications following LLIF.
D. Trend of the incidence of visceral organ complications following LLIF.
The most common complication was sensory deficit (66 patients, 0.5%), followed by motor deficit (57 patients, 0.43%) and weakness of psoas muscle (29 patients, 0.22%). Major vessel injury occurred in 17 patients (0.13%), and bowel injury developed in 5 patients (0.04%). The incidence of these two complications (Major vessel injury and bowel injury) per year ranged from 0.05% to 0.21% and from 0% to 0.13%, respectively.
Among the 17 patients with major vessel injuries, 5 cases (0.08%) were via the transpsoas approach and 12 cases (0.17%) were via the prepsoas approach (p=0.151). Six patients had spinal deformity, six patients had lumbar degenerative spondylolisthesis, three patients had spinal canal stenosis, and one patient had osteoporotic vertebral fracture and adjacent segment disease. The major vessel injuries were caused by discectomy, trial cage insertion, dissection, pin insertion, anterior blade insertion, and unknown for 6, 3, 2, 1, and 4 cases, respectively.
Among the complications other than the preselected variables, abdominal wall palsy (18 patients) and implant-related complications (0.14%) were the most common, and neurological complications (recovered within 3 months) were the second most common (0.11%, Table 2). Segmental artery injury occurred in seven patients (0.05%), and three of these patients (0.02%) required surgical interruption. The incidence of miscellaneous complication ranges from 0.21% to 1.91% with mean of 0.82%, and no trend was found in the follow-up period. There were four patients who died (0.03%) because of causes related to complications. The causes of death included major vessel injuries in three patients and ischemia of the intestine in one patient.
Table 2.
Description of Miscellaneous Complications Following Lateral Lumbar Interbody Fusion Surgery.
| Type of complications | Numbers and
incidence |
|---|---|
| Abdominal wall palsy | 18 (0.14%) |
| Implant-related complication | 18 (0.14%) |
| Neurological complication (<3 months) | 15 (0.11%) |
| Pelvic wing fracture | 7 (0.05%) |
| Segmental artery injury | 7 (0.05%) |
| Hematoma | 6 (0.05%) |
| Pulmonary embolism | 6 (0.05%) |
| Anterior longitudinal ligament rupture (<3 months) | 3 (0.02%) |
| Dural tear | 3 (0.02%) |
| Deep vein thromboembolism | 3 (0.02%) |
| Vertebral fracture (did not require reoperation) | 3 (0.02%) |
| Gallstone cholecystitis | 2 (0.02%) |
| Lymphatic vessel injury | 2 (0.02%) |
| Pneumonia | 2 (0.02%) |
| Urinary tract infection | 2 (0.02%) |
| Acute median arcuate ligament syndrome | 1 (0.01%) |
| Anaphylactic shock | 1 (0.01%) |
| Appetite loss | 1 (0.01%) |
| Cerebral infarction | 1 (0.01%) |
| Constipation | 1 (0.01%) |
| Cyst formation of the vertebral body | 1 (0.01%) |
| Pyelonephritis | 1 (0.01%) |
| Prolonged inflammatory response | 1 (0.01%) |
| Retroperitoneal lymphatic cyst | 1 (0.01%) |
| Subcutaneous emphysema | 1 (0.01%) |
| Wound dehiscence | 1 (0.01%) |
| Wrong level surgery | 1 (0.01%) |
| Total | 109 (0.82%) |
Etiologies of LLIF patients with complications
Among the 389 complications, almost half of the complications developed in spinal deformity surgeries (191 patients, 49.4%; Fig. 3). Although we did not know the total number of LLIF for each disease, it can be suggested that the complication rate of LLIF for spinal deformities will be significantly high.
Figure 3.
Breakdown of the diseases in LLIF patients with complications.
A total of 49.4% and 22.1% of the complications developed during spinal deformity surgery and in patients with lumbar spinal canal stenosis, respectively.
Comparisons of the incidence and type of complications associated with the transpsoas and prepsoas approaches
The transpsoas approach was associated with more frequent complications than the prepsoas approach during the study period (transpsoas approach 3.55% and prepsoas approach 2.40%; p<0.001). Among the complications, statistically frequent perivertebral organ injury occurred in the transpsoas approach (transpsoas vs. prepsoas approach, 111 patients [1.79%] vs. 74 patients [1.05%]; p<0.001; Table 3).
Table 3.
Comparisons of the Incidence of Perivertebral Organ Injury between Transpsoas and Prepsoas Approaches).
| Development of complications | Transpsoas
approach |
Prepsoas
approach |
Total |
|---|---|---|---|
| Case with complication | 111 (1.79%) | 74 (1.05%) | 185 (1.40%) |
| Case without complication | 6,087 | 6,973 | 13,060 |
| Total | 6,198 | 7,047 | 13,245 |
Chi-square statistic=13.140; p-value<0.001. Perivertebral organ injury (weakness of psoas [>3 months], motor deficit [>3 months], sensory deficit [>3 months], vertebral body injury [required reoperation], and anterior longitudinal ligament rupture [required reoperation]). Percentage in parentheses.
Conversely, there was a trend toward a higher incidence of visceral organ complications associated with the prepsoas approach than with the transpsoas approach, although the difference was not statistically significant (transpsoas vs. prepsoas approach, 17 patients [0.27%] vs. 25 patients [0.35%]; p=0.411; Table 4).
Table 4.
Comparisons of the Incidence of Visceral Organ Complications between Transpsoas and Prepsoas Approaches).
| Development of complications | Transpsoas
approach |
Prepsoas
approach |
Total |
|---|---|---|---|
| Case with complication | 17 (0.27%) | 25 (0.35%) | 42 (0.32%) |
| Case without complication | 6,181 | 7,022 | 13,203 |
| Total | 6,198 | 7,047 | 13,245 |
Chi-square statistic=0.676; p-value=0.411. Visceral organ complications (major vessel, ureter, renal, bowel [including peritoneal injury], and lung [including pleural injury] injuries. Percentage in parentheses.
Discussion
Of the 13,245 LLIF patients registered in the JSSR Web database between 2015 and 2020, 6,198 patients (46.8%) were treated with the transpsoas approach and 7,047 (53.2%) were treated with the prepsoas approach. Three hundred eighty-nine complications occurred in 366 patients (2.76%), with a significantly higher incidence in the transpsoas approach (3.55%) than in the prepsoas approach (2.40%) during the study period. Among the complications, major vessel, nerve, and lung injury and deep infection occurred in 0.13%, 0.21%, 0.05%, 0.04%, and 0.19% of patients, respectively.
Deaths due to complications occurred in four patients. Three of these deaths were due to major vessel injuries, and one death was related to ischemia of the intestine. Death related to the LLIF is rare but has been reported in the previous literature5,11-13). In a systematic review, Hiji et al. reported a perioperative mortality rate of 0.73% for LLIF5). Assina et al. described a patient who died because of major vessel injury caused by a surgical retractor (anterior blade) in the LLIF, and other deaths due to postoperative Ogilvie syndrome (acute pseudoenteric obstruction) and intestinal injury have been reported11-13).
In the present study, major vessel injury cases were reported in 17 patients (5 and 12 with transpsoas and prepsoas approaches, respectively), and 3 of the cases resulted in death despite intensive treatment by a cardiovascular department. The major vessel injuries were caused by discectomy and trial cage, pin, and anterior blade insertions. Because the complications of these patients did not necessarily occur during surgery for difficult spinal deformities, more careful dissection of the intervertebral disc and proper positioning of the trial cage during insertion were considered important. In their review of the literature, Epstein et al. described a frequency of 0%-0.4% of major vessel injuries in the LLIF14). In the previous literature, the majority of injuries occur at the L4-L5 level, and thus, Epstein et al. advocated that in addition to careful intraoperative techniques, adequate preoperative planning, including evaluation of the trajectory of the common iliac vein, is important14). Furthermore, we believe that it is important for each institution to establish a sufficient system to respond to a major vessel injury, including close collaboration with other departments, such as cardiothoracic and vascular surgery departments, and with facilities that can immediately transport the patient to the hospital.
Motor deficits exceeding 3 months occurred in 57 patients, of which 19 (28.1%) had no neuromonitoring system. Although it is highly anticipated that the experience of each surgeon may reduce the incidence of postoperative motor deficits in LLIF, it is considered necessary to further promote the use of an intraoperative neuromonitoring system to mitigate the risk of motor deficits.
Comparisons of the two different approaches indicated that statistically frequent perivertebral organ injury occurred in the transpsoas approach, and the incidence of visceral organ complications was high in the prepsoas approach, although the difference was not statistically significant.
The difference in the type and frequency of complications is reasonable considering the difference in the route of entry between the two approaches. In the transpsoas approach, an incision is made from the lateral aspect, and the psoas major muscle is divided along its course to reach the lateral aspect of the vertebral body, avoiding lumbar nerve roots and the genitofemoral and ilioinguinal nerves. Conversely, in the prepsoas approach, the vertebral body is reached obliquely and anteriorly from the anterior border of the psoas major muscle, avoiding the visceral organs. The reason why injuries to visceral organs are more common in the prepsoas approach and nerve injuries are more common in the transpsoas approach may be because the surgery is performed in the vicinity of these organs in each technique15).
Conversely, in the analysis by disease, half of the complications developed during surgery for spinal deformities (49.4%), and this was consistent throughout the study period (range 44.4%-53.6%). Although the complication rate for each disease cannot be calculated because the number of LLIF in each disease is unknown, it is considered that the complication rate is higher for surgeries of spinal deformities than for those of other conditions.
Several possible reasons may exist. First, LLIF for spinal deformities is often performed at multiple intervertebral levels, including the L4-L5 level, and the lengthy retraction of the femoral nerve might be the reason for postoperative neurological complications. Second, it is often difficult to recognize the rotation of the vertebral body via fluoroscopy in patients with spinal deformity and osteophytes often need to be excised, making LLIF a challenging procedure. Therefore, LLIF for spinal deformities should be performed only after the surgeon has acquired sufficient surgical skill and proficiency in the procedure.
Several limitations must be acknowledged. First is the limited type of instrument used in the cases included in this study. These web-based questionnaires did not include the material information; thus, we were unable to show the manufacturer and actual materials of each case. However, we believe that CoRoentⓇ XLIF implants (NuVasive, San Diego, CA) and OLIF25™ (Medtronic plc., Minneapolis, MN) were used for the vast majority of transpsoas and prepsoas cases, respectively. This limited type of instrumentations used in the LLIF cases potentially affected the type and incidence of complications while both CoRoentⓇ XLIF implants (NuVasive, San Diego, CA) and OLIF25™ (Medtronic plc., Minneapolis, MN) systems are commonly used instrument in LLIF cases. Second is the lack of surgeon experience data for the questionnaire. It is widely accepted that surgical experience and the number of cases operated affect complication rate in surgery. However, because these items were excluded in the present question, the results of this study cannot be extrapolated to the complication rate LLIF performed by experienced surgeons. Third is the response rate of the questionnaire. The total number of LLIF cases used in the market survey during the same period was 33,801, including 15,379 and 18,422 cases for the transpsoas and prepsoas approaches, respectively. This number is the total number of LLIF cases used during the entire study period and does not reflect the number of surgeries, because LLIF are generally often considered to involve multiple vertebrae. However, the overall response rate is estimated to be approximately 39% (Supplemental fig. and table). The response rate at the time of the first survey by Fujibayashi et al., which was estimated similarly, was 86%, showing a marked decrease in the estimated response rate15,16). This may be mainly due to the lengthy period of the survey. It is well known that a prolonged questionnaire survey is burdensome to survey participants and generally results in a lower response rate than that in a single time survey. The Japan Kidney Disease Council and the Japan Dialysis Association have conducted a nationwide survey on the medical care and life of patients with renal failure every 5 years since 1986, after the introduction of dialysis17). In the most recent report in 2016, they reported that only 12.8% of the 923 facilities they requested ended up cooperating and only 3.8% of the 324,986 patients for chronic dialysis in Japan were eligible for the survey17). However, Curtin et al. examined the effect of low survey response rates on the estimated value of the consumer sentiment index (ICS)18). Curtin et al. reported that excluding respondents who refused to cooperate did not affect the ICS estimates using the remaining responses18). Holbrook et al. examined whether low survey response rates are associated with demographic surveys using results from 81 national surveys with response rates ranging from 5% to 54% and found that surveys with very low response rates were less reliable but that these low rates did not significantly affect the final results19). In the present study, the incidence of both visceral organ and perivertebral organ injuries was similar to that in the first survey (present study: visceral organ injury 0.32% and perivertebral organ injury 1.40%; first survey: visceral organ injury 0.17% and perivertebral organ injury 1.40%), indicating that the registered patients represented the total cohort4). Furthermore, the results of the present study were comparable with those of the meta-analysis by Walker et al. described earlier (major vascular injury 0.58% and bowel injury 0.09%, SSI 0.28%)6). However, even taking these recent survey results into consideration, it is important to improve the survey response rate, even to consider giving incentives for cooperating institutions, to obtain more useful information in future surveys on complications of surgical procedures.
In this nationwide survey on the LLIF between 2015 and 2020, the complication rate remained low and similar to that in the previous literatures. Because serious complications, including deaths, were not always reported in LLIF for spinal conditions that are considered technically difficult, it is assumed that various factors, such as the surgical skill and experience of the surgeon, the disease, and the level of intervertebral disc treated, are involved in the occurrence of complications.
The use of new surgical technology, such as LLIF, has the potential to provide patients with the best possible care. Conversely, the use of new surgical technology has the potential to cause inadvertent harm to patients. Surgeons and institutions must be familiar with the surgical techniques and be prepared for intraoperative complications and other shortfalls to mitigate the risk of surgical complications.
Conclusions
We conducted a nationwide survey on complications following LLIF between 2015 and 2020. The overall complication rate was 2.76%, and 0.74% of the patients required revision surgery related to complications. Four patients died in relation to complications. The transpsoas approach was associated with more frequent complications than the prepsoas approach LLIF may be beneficial for lumbar degenerative conditions with acceptable complication rates; however, the occurrence of fatal vessel and bowel injuries should not be overlooked. The indication for surgery for spinal deformity should be carefully determined by the experience of the surgeon and the extent of deformity.
Disclaimer: Sumihisa Orita and Nobuyuki Fujita are among the Editors of Spine Surgery and Related Research and on the journal's Editorial Committee. They were not involved in the editorial evaluation or decision to accept this article for publication at all.
Conflicts of Interest: Mitsuru Yagi, Nobuyuki Fujita, Tomohiko Hasegawa, Gen Inoue, Yoshihisa Kotani, Seiji Ohtori, Sumihisa Orita, Yasushi Oshima, Daisuke Sakai, Toshinori Sakai, Daisuke Togawa, Kazuo Nakanishi, Hiroaki Nakashima, Toshitaka Yoshii, Masaya Nakamura, Motoki Iwasaki, Tokumi Kanemura, and Hirotaka Haro declare that there are no relevant conflicts of interest.
Seiji Ohtori received a research fund from Medtronic Sofamor Danek.
Hiroshi Taneichi received a research fund and speaker's bureau from Medtronic Sofamor Danek.
Naobumi Hosogane received a research fund and speaker's bureau from NuVasive and received a research fund from Medtronic Sofamor Danek.
Masahiko Watanabe received a research fund from ASAHI KASEI PHARMA CORPORATION; Johnson & Johnson; Medtronic Sofamor Danek; Stryker; Eisai Co., Ltd.; Zimbie, NuVasive; Smith & Nephew Orthopedics; Lima Corporate; and Nippon Zoki Pharmaceutical Co., Ltd.
Sources of Funding: None
Author Contributions: Mitsuru Yagi designed the study and wrote the manuscript; 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, and Toshitaka Yoshii provided critical reagents; Masaya Nakamura, Motoki Iwasaki, Masahiko Watanabe, Hirotaka Haro, Tokumi Kanemura, and Naobumi Hosogane supervised the study.
Ethical Approval: This study was approved by the Ethics Committee of Keio University Hospital (Approval number # 20180011).
Informed Consent: Informed consent for publication was obtained from all participants in this study.
Supplementary Materials
Acknowledgement
We would like to thank all JSSR members for their dedication and commitment to this study.
References
- 1.Gates M, Tang AR, Godil SS, et al. Defining the relative utility of lumbar spine surgery: a systematic literature review of common surgical procedures and their impact on health states. J Clin Neurosci. 2021;93:160-7. [DOI] [PubMed] [Google Scholar]
- 2.Tan MWP, Sayampanathan AA, Jiang L, et al. Comparison of outcomes between single-level lateral lumbar interbody fusion and transforaminal lumbar interbody fusion: a meta-analysis and systematic review. Clin Spine Surg. 2021;34(10):395-405. [DOI] [PubMed] [Google Scholar]
- 3.Barbagallo GMV, Albanese V, Raich AL, et al. Lumbar lateral interbody fusion (LLIF): comparative effectiveness and safety versus PLIF/TLIF and predictive factors affecting LLIF outcome. Evid Based Spine Care J. 2014;5(1):28-37. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 4.Fujibayashi S, Kawakami N, Asazuma T, et al. Complications associated with lateral interbody fusion: nationwide survey of 2998 cases during the first 2 years of its use in Japan. Spine. 2017;42(19):1478-84. [DOI] [PubMed] [Google Scholar]
- 5.Hijji FY, Narain AS, Bohl DD, et al. Lateral lumbar interbody fusion: a systematic review of complication rates. Spine J. 2017;17(10):1412-9. [DOI] [PubMed] [Google Scholar]
- 6.Walker CT, Farber SH, Cole TS, 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. [DOI] [PubMed] [Google Scholar]
- 7.Uribe JS, Deukmedjian AR. Visceral, vascular, and wound complications following over 13,000 lateral interbody fusions: a survey study and literature review. Eur Spine J. 2015;24(suppl 3):386-96. [DOI] [PubMed] [Google Scholar]
- 8.Lehmen JA, Gerber EJ. MIS lateral spine surgery: a systematic literature review of complications, outcomes, and economics. Eur Spine J. 2015;24(suppl 3):287-313. [DOI] [PubMed] [Google Scholar]
- 9.Abbott D. Applied predictive analytics: principles and techniques for the professional data analyst. 1st ed. Hoboken: John Wiley & Sons Inc; 2014. [Google Scholar]
- 10.Manabe T, Akatsu H, Kotani K, et al. Trends in clinical features of novel coronavirus disease (COVID-19): a systematic review and meta-analysis of studies published from December 2019 to February 2020. Respir Investig. 2020;58(5):409-18. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 11.Assina R, Majmundar NJ, Herschman Y, et al. First report of major vascular injury due to lateral transpsoas approach leading to fatality. J Neurosurg Spine. 2014;21(5):794-8. [DOI] [PubMed] [Google Scholar]
- 12.Januszewski J, Keem SK, Smith W, et al. The potentially fatal Ogilvie's syndrome in lateral transpsoas access surgery: a multi-institutional experience with 2930 patients. World Neurosurg. 2017;99:302-7. [DOI] [PubMed] [Google Scholar]
- 13.Bode WE, Beart RW Jr, Spencer RJ, et al. Colonoscopic decompression for acute pseudoobstruction of the colon (Ogilvie's syndrome): report of 22 cases and review of the literature. Am J Surg. 1984;147(2):243-5. [DOI] [PubMed] [Google Scholar]
- 14.Epstein NE. Incidence of major vascular injuries with extreme lateral interbody fusion (XLIF). Surg Neurol Int. 2020;11:70. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 15.Li HM, Zhang RJ, Shen CL. Differences in radiographic and clinical outcomes of oblique lateral interbody fusion and lateral lumbar interbody fusion for degenerative lumbar disease: a meta-analysis. BMC Musculoskelet Disord. 2019;20(1):582. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 16.Aguirre AO, Soliman MAR, Azmy S, et al. Incidence of major and minor vascular injuries during lateral access lumbar interbody fusion procedures: a retrospective comparative study and systematic literature review. Neurosurg Rev. 2022;45(2):1275-89. [DOI] [PubMed] [Google Scholar]
- 17.Nitta K, Nakai S, Masakane I, et al. 2018 annual dialysis data report of the JSDT renal data registry: patients with hepatitis. Ren Replace Ther. 2021;7(1):22. [Google Scholar]
- 18.Curtin R, Presser S, Singer E. The effects of response rate changes on the index of consumer sentiment. Public Opin Q. 2000;64(4):413-28. [DOI] [PubMed] [Google Scholar]
- 19.Holbrook AL, Krosnick JA, Pfent A. The causes and consequences of response rates in surveys by the news media and government contractor survey research firms. In: Lepkowski JM, Tucker NC, Brick JM, et al, editors. Advances in telephone survey methodology. Hoboken: Wiley; 2007. p. 499-528. [Google Scholar]
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