Study design/setting: A community hospital prospective, nonrandomized chart review. March 2004 to December 2006, 58 patients were treated. Adverse events: new complaints and increasing length of stay limit early mobilization and require consultation with other physicians or reoperation. These formed the focus of the study.
Objective: Assess patient demographics and adverse events related to direct lateral lumbar approach.
Summary of background data: Clinicians advocate anterior column support for lumbar conditions. Minimally invasive stabilization of lumbar spine via direct lateral approach gained popularity owing to perceived decrease in patient morbidity.
Methods: Mild or major adverse events during hospital stay or within 6 weeks of discharge were considered early complications and designated as medical, approach, or implant related. A historical cohort of open posterior spinal fusion patients was used for comparison.
Results: Forty-three female and 15 male patients with a mean age of 61 years formed the study group. Surgery performed included 38 single level, 19 2-level, and 1 3-level case. Adverse events occurred in 13 patients (22.4%); 8 events were approach, 3 medical, and 1 implant bone interface related. Major complications occurred in 5 patients (8.6%). Two patients (3.4%) with L4 nerve injury showed residual motor effects, at 1 year postoperatively. Significant differences were noted between single and 2-level cases; Estimated blood loss (EBL) and operative time. Open posterior fusion patients experienced greater operative time and increased EBL compared with minimally invasive cases.
Conclusions: Major adverse events approximated 8.6% with approach-related complaints of nerve irritation nearing 3.4%. Mild complications occurred in 13.7% of patients. Meralgia paresthetica was a primary approach-related complaint. Most complaints significantly reduced by first postoperative visit. One patient (1.7%) had symptoms lasting over a year that did not adversely affect function. Significant finding related to exposure, that is, 1-versus 2-level cases. Overall morbidity reduction noted by EBL is considerably less compared with the historical cohort. Direct lateral lumbar interbody fusion has proven to be of value.