Analysis of operative complications in a series of 471 anterior lumbar interbody fusion procedures

This retrospective review compares the intraoperative and perioperative complications associated with the placement of threaded devices and nonthreaded devices used in anterior lumbar interbody fusions. Anterior lumbar interbody fusion is a common procedure performed with either a nonthreaded device, such as a femoral ring, or a threaded device, such as with a cage or a bone dowel. Many studies have been done detailing the fusion rates and biomechanical properties of both devices. However, few studies have been performed evaluating acute complications between the two device types. A retrospective chart review was performed of 471 consecutive patients who underwent anterior lumbar interbody fusion: 243 with a nonthreaded interbody device and 228 with a threaded interbody device. Operative notes, anesthesia reports, discharge summaries, and follow-up notes were reviewed from 1992 to June 2002. The patients' demographics, diagnosis, number of levels fused, type of device used, length of hospital stay, and acute complications, either intraoperative or perioperative, were collected and analyzed. Approximately 4.8% of patients with a threaded type interbody device had an intraoperative complication whereas only 0.4% of patients with a nonthreaded type device had an intraoperative complication. There was a significant association between interbody device type (threaded vs. nonthreaded) and occurrence of an intraoperative complication (P = 0.0024). Placement of threaded devices, such as cages or bone dowels, was associated with a higher acute complication rate than was the placement of nonthreaded devices during anterior lumbar interbody fusion.