• Kazuyoshi Kobayashi, Kei Ando, Fumihiko Kato, Tokumi Kanemura, Koji Sato, Yudo Hachiya, Yuji Matsubara, Mitsuhiro Kamiya, Yoshihito Sakai, Hideki Yagi, Ryuichi Shinjo, Yoshihiro Nishida, Naoki Ishiguro, and Shiro Imagama.
• Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65, Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8560, Japan.
• Eur Spine J. 2018 Aug 1; 27 (8): 1972-1980.

PurposePosterior lumbar interbody fusion (PLIF)/transforaminal lumbar interbody fusion (TLIF) can have complications that require reoperation. The goal of the study was to identify risk factors for reoperation within 2 years after PLIF/TLIF.MethodsA retrospective analysis of a prospective multicenter database was performed for patients who underwent PLIF/TLIF. A total of 1363 patients (689 males and 674 females) were identified, with an average age of 65.9 years old. Comorbidities, perioperative ASA grade, and operative factors were compared between patients with and without reoperation. Risk factors for reoperation were identified in multivariate logistic analysis.ResultsThere were 38 reoperations within 2 years after PLIF/TLIF (2.8%). The original surgical procedures were open PLIF (n = 26), open TLIF (n = 10), and minimally invasive surgery (n = 2). Reoperation was due to adjacent segment degeneration (ASD) (n = 10), surgical site infection (SSI) (n = 9), screw misplacement (n = 6), postoperative epidural hematoma (n = 6), pseudoarthrosis (n = 4), and cage protrusion (n = 3). Number of levels fused and dural tear were significantly associated with reoperation. In analysis of complications requiring reoperation, SSI was related to diabetes mellitus and dural tear, and postoperative epidural hematoma was related to fusion of two or more levels, EBL, and operation time. In multivariate logistic regression, fusion of two or more levels (HR 2.19) was significantly associated with reoperation.ConclusionSurgical invasiveness, as reflected by number of fused levels, operation time, EBL and dural tear, was associated with reoperation. Fusion of two or more levels is a strong risk factor for reoperation within 2 years after initial PLIF/TLIF. These slides can be retrieved under Electronic Supplementary Material.

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