Background context:
The transforaminal lumbar interbody fusion (tlif) procedure has become an increasingly popular means of obtaining a circumferential fusion while avoiding the morbidity of the anterior approach. concerns remain, however, regarding the clinical efficacy and safety of its use.
Purpose:
The purpose of this study was to evaluate the complications of the single-level tlif procedure. the difference in complications observed with the use of iliac crest autograft compared with rhbmp-2 will be assessed.
Study design:
Retrospective cohort study; a review of complications.
Methods:
Patients who underwent a single-level tlif between january 2004 to may 2007 with either autograft iliac crest or rhbmp-2 were identified. a retrospective review of these patients included operative reports, pre- and postoperative medical records, most recent postoperative dynamic and static lumbar radiographs, and computed tomography scans (when available).
Results:
A total of 130 patients met the study criteria; 119 patients were available for follow-up, with an average radiographic follow-up of 19.1 months and an average clinical follow-up of 27.6 months. thirty-three patients received iliac crest autograft and 86 patients received rhbmp-2. complications occurred in 40 of the 119 study patients (33.6%). the autograft group had a higher complication rate (45.5% vs. 29.1%), but the difference was not statistically significant (p=.09). complications in the autograft group included persistent donor-site pain (30.3%), donor-site infection (3.1%), lumbar wound infection (6.1%), and postoperative radiculitis (3.0%). complications in the rhbmp-2 group included postoperative radiculitis (14.0%), vertebral osteolysis (5.8%), ectopic bone formation (2.3%), and lumbar wound infection (3.5%). a hydrogel sealant (duraseal; confluent surgical inc., waltham, ma, usa) was used in 37 out of 86 patients in the rhbmp-2 group. the use of this sealant decreased the rate of postoperative radiculitis in the rhbmp-2 group from 20.4% to 5.4% (p=.047). the radiographic nonunion rate at most recent follow-up was 3.0% in the autograft group and 3.5% (p=.90) in the rhbmp-2 group.
Conclusions:
The most common complications in the autograft group were related to the donor site. the most common complication in the rhbmp-2 group was postoperative radiculitis, the incidence of which is reduced by the use of a hydrogel sealant.