Perioperative Risk Factors for Early Revisions in Stand-Alone Lateral Lumbar Interbody Fusion

Lateral lumbar interbody fusion can be performed without supplemental posterior instrumentation. Previous reports have shown favorable results with stand-alone lateral lumbar interbody fusion (SA-LLIF); however, a reoperation rate of up to 26% has been reported. It remains unclear what perioperative factors are associated with early failure after SA-LLIF. The objective of this study is to determine perioperative factors that increase the risk of early revisions after SA-LLIF.

Data of consecutive patients with SA-LLIF were reviewed. All revisions or recommendations for revision surgery within 12 months after the LLIF procedure were documented. As potential contributors, operative levels, preoperative clinical diagnosis, number of fusion levels, and the average L1/L2 quantitative computed tomography-volumetric bone mineral density value were obtained along with other demographic factors. Cage subsidence (grade 0-III as per Marchi et al.), was also evaluated in patients who had radiographs/computed tomography between 6 and 12 months postoperatively (n = 122). Logistic regression analyses were conducted.

Of 133 eligible patients, 21 (15.8%) underwent revision surgery and 4 (3.0%) were recommended for revision surgery within 1 year primarily because of neurologic symptoms or pain (68%). Baseline demographics showed no significant difference between the revision and the nonrevision group. The average number of levels fused was 2.12 (revision group) and 2.14 (nonrevision group) (P = 0.55). Significantly more patients in the revision group had the diagnosis of foraminal stenosis (64.0% vs. 39.8%; P = 0.04).

Patients with foraminal stenosis were more likely to have early revision surgery after SA-LLIF primarily because of neurologic symptoms/pain. This information can assist in preoperative discussions and management of patient expectations.