Each approach was also associated with its own unique complications. Complications compound library more likely to be found in the open TLIF approach include infections and muscular trauma as a result of the increased exposure and soft tissue dissection . In addition, increased exposure has been shown to be potentially associated with 23.5% of reported complications being infectious in nature, within the open TLIF studies. Open TLIF may have a slightly lower rate of neurological complications, for neurological deficits were a considerably lower proportion of total complications, 11.8%, when compared to MI-TLIF’s 20.7%. However, there were a greater variety of unique complications to open TLIF, as shown by 23.4% of complications coming in the form of dural tears, ileus, and atelectasis among others.
Please refer to Table 3 for further analysis. Table 3 Complications found in studies comparing open TLIF to MI-TLIF. In the MI-TLIF literature reviewed, many authors discussed the challenging learning curve associated with MI-TLIF, which makes certain complications, particularly those related to instrumentation more likely . Endoscopic visualization of the spinal structure limits the field of view for the surgeon, making identification of already unfamiliar landmarks even more difficult. Though visualization techniques have improved over time, percutaneous fixation systems do not have the ability to reposition three dimensionally . Tubular dilator retractors can result in poor decompression while resulting in higher rates of neurological injuries .
Of all complications presented in the MI-TLIF comparative literature, approximately 1 in 5 were related to neurological complications (Table 4). Schizas et al. wrote of possible inexperience leading to inappropriate placement of transpedicular screws, and inadequate preparation of intervertebral cage and fusion site which can lead to further instrumentation related complications. Table 4 Complication rate by TLIF approach. The operative surgeon additionally must be familiar with 3D lumbar anatomy and be able to carefully interpret 2D radiographic images to make a mental reconstruction. This is a unique skill and one that is not as critical with a traditional, open approach. The surgeon must be able to read anterior-posterior and lateral imaging in order to accurately insert percutaneous pedicle screws, thereby allowing for possible misinterpretation leading to complications .
Screw misplacement and cage migration or subsidence accounted for 44.8% of complications reported in MI-TLIF comparative studies. Radiation exposure is another area of interest. MI-TLIF itself presents AV-951 with increased risk to the surgeon related to increased radiation exposure due to lengthened intraoperative fluoroscopy times.