Prospective Study of Postoperative Complications after Lateral Lumbar Interbody Fusion
Presented at SMISS Annual Forum 2014
By Brian Kwon MD
Disclosures: Brian Kwon MD B; Medtronic, ETEX Corp., C; Medtronic, D; ETEX Corp.
Lateral lumbar interbody fusion (LLIF) is a newer surgical technique with much enthusiasm, however significant approach-related complications have raised awareness towards consistently reporting and avoidance of these post-operative events.
We created a short, patient-reported questionnaire to prospectively record and measure post-operative groin and thigh numbness or pain, hip flexor and quadriceps weakness as well as other lower extremity weakness with the goal of studying the true incidences of these symptoms but also analyze the temporal course of these symptoms.
A 5 domain questionnaire (CLIQ, Complications after LLIF Questionnaire) was devised that encompasses the commonest post-operative complaints attributable to LLIF. The domains are rated on a non-quantitative, ordinal scale with 6 grades (0 to 5). The maximum score of the 5 domains is 25. There were 53 patients who had LLIF surgery performed between July 2009 to May 2012 and CLIQ was given from June 2011 to June 2012. At each follow-up visit each patient was given the same questionnaire at each post-operative visit until their 12 month follow-up. This resulted in a total of 113 inputs. Data analysis was performed by a statistician using SPSS software. We used a polynomial, mathematical analysis technique that describes multiple data points that fit neither a linear or quadratic function, i.e. B-spline technique.
Our data revealed a rapid decrease in CLIQ scores in the first 90 days postop. Scores then plateau and remain low up to 1 year. Multi-regression analysis of 3 groups - 1-, 2- and 3-level fusions - revealed statistically significant differences in the recovery curves over time. While all had similar patterns of recovery it appears the groups differed by severity of symptoms.
We have described a prospective, patient-reported outcomes questionnaire that is easy to administer and able to measure recovery of and severity of symptoms between 1-, 2-, and 3-level lumbar fusion surgeries. Using CLIQ, we can objectively describe postoperative complications following LLIF which will enable surgeons to more accurately assess to efficacy of interventions for decreasing or eliminating these complications.