Early complications of extreme lateral interbody fusion in the obese

A retrospective review of prospective data of all patients undergoing extreme lateral interbody fusion (XLIF) for degenerative disease of the lumbar and thoracic spine.

To compare between obese and nonobese patients, the incidence of early complications and predictive factors affecting complication rate.

XLIF is a 90-degree off midline approach that allows for large graft placement, excellent disk height restoration, and indirect decompression at the stenotic motion segment. As the psoas muscle is traversed, the lumbosacral plexus is protected by the use of automated electrophysiology through dynamic discrete evoked electromyogram thresholding. Exposure is achieved with an expandable split-blade retractor, which allows for direct illuminated visualization facilitating discectomy and complete anterior column stabilization by using a large load-bearing implant that rests on the dense ring apophysis bilaterally.

A retrospective chart review of a prospectively compiled database of all patients treated with the XLIF procedure between October 2006 and July 2008 was completed. Early complications were defined as any adverse events occurring within the first 3 months of the index procedure. The National Institute of Health Guidelines for defining obesity relating to body mass index were used.

Out of 432 patients, 313 have complete data: 156 obese, 157 nonobese. The ages, comorbidities, earlier surgeries, and diagnoses were equivalent. There were no transfusions and no infections. Complications were minimal and about the same in each group.

Unlike traditional open lumbar fusion procedures, minimally invasive surgery (XLIF) has no greater risk of complication in the obese patient.