J Korean Neurosurg Soc.  2024 Sep;67(5):550-559. 10.3340/jkns.2023.0238.

A Comprehensive Analysis of Potential Complications after Oblique Lumbar Interbody Fusion : A Review of Postoperative Magnetic Resonance Scans in Over 400 Cases

• Lee KH
• Lee SH
• Lee JS
• Kim YH
• Sung SK
• Son DW
• Lee SW
• Song GS

• KMID: 2558680
• DOI: http://doi.org/10.3340/jkns.2023.0238

Abstract

Objective
: This study focuses on identifying potential complications following oblique lumbar interbody fusion (OLIF) through routine magnetic resonance (MR) scans.
Methods
: From 650 patients who underwent OLIF from April 2018 to April 2022, this study included those with MR scans taken 1-week post-operatively, and only for indirect decompression patients. The analysis evaluated postoperative MR images for hematoma, cage insertion angles, and indirect decompression efficiency. Patient demographics, post-operatively symptoms, and complications were also evaluated.
Results
: Out of 401 patients enrolled, most underwent 1- or 2-level OLIF. Common findings included approach site hematoma (65.3%) and contralateral psoas hematoma (19%). The caudal level OLIF was related with less orthogonality and deep insertion of cage. Incomplete indirect decompression occurred in 4.66% of cases but did not require additional surgery. Rare but symptomatic complications included remnant disc rupture (four cases, 1%) and synovial cyst rupture (four cases, 1%).
Conclusion
: This study has identified potential complications associated with OLIF, including approach site hematoma, contralateral psoas hematoma, cage malposition risk at caudal levels, and radiologically insufficient indirect decompression. Additionally, it highlights rare, yet symptomatic complications such as remnant disc rupture and synovial cyst rupture. These findings contribute insights into the relatively under-explored area of OLIF complications.

Keyword

Lumbar vertebrae; Spinal fusion; Postoperative complications; Magnetic resonance imaging; Oblique lumbar interbody fusion

Figure

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  Fig. 1. Landmarks for oblique lumbar interbody fusion cage insertion. A : Anteroposterior image : the middle radiopaque marker of the cage does not push beyond the spinous process. B : Lateral image : the most dorsal radiopaque marker of the cage does not surpass the posterior margin of the upper vertebral body.

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  Fig. 2. Evaluation of approach site or contralateral site hematoma. A : Red circle : approach site hematoma (more than 10 mL). B : Blue circle : contralateral site hematoma (scanty). C : Red arrows : approach site hematoma more than 30 mL.

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  Fig. 3. Measurement of cage insertion angle and depth (red arrow). Cage depth was determined by drawing an extension line following the cage’s posterior margin and measuring the distance to the right border of the body (red arrow : 4.72 mm). The cage angle was measured as the Cobb angle between an imaginary line connecting both facet joints and the imaginary line passing through the center of the cage (red dotted lines).

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  Fig. 4. The relationship between cage insertion angle (A) and cage insertion depth (B) according to the level. Values are presented as mean ±standard deviation. *Indicate statistical significance compared to L2/3.

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  Fig. 5. Remnant disc rupture cases. Central disc rupture (A), disc rupture on the contralateral neural foremen, with deep cage insertion (B), disc rupture on the contralateral neural foremen, without deep cage insertion but accompanying right foot drop (C and D). Blue arrows : remnant disc rupture, red arrow : root.

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  Fig. 6. Synovial cyst rupture. A-C : Synovium rupture after surgery, but with mild symptoms. D : Synovium rupture and bilateral foot drop after surgery. Blue arrows : synovium rupture.

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Reference

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