Structured Abstract Background Context Lateral lumbar interbody fusion (LLIF) is a frequently utilized technique for the treatment of lumbar pathology. Despite its overall success, LLIF has been ...associated with a unique set of complications. However, there has been inconsistent evidence regarding the complication rate of this approach. Purpose To perform a systematic review analyzing the rates of medical and surgical complications associated with LLIF. Study Design Systematic Review Patient Sample 6819 patients who underwent LLIF reported in clinical studies through June 2016. Outcome Measures Frequency of complications within cardiac, vascular, pulmonary, urologic, gastrointestinal, transient neurologic, persistent neurologic, and musculoskeletal/spine (MSK) categories. Methods This systematic review was performed utilizing the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Relevant studies that identified rates of any complication following LLIF procedures were obtained from PubMed, MEDLINE, and EMBASE databases. Articles were excluded if they did not report complications, presented mixed complication data from other procedures, or were characterized as single case reports, reviews, or case series containing less than 10 patients. The primary outcome was frequency of complications within cardiac, vascular, pulmonary, urologic, gastrointestinal, transient neurologic, persistent neurologic, and musculoskeletal/spine (MSK) categories. All rates of complications were based on the sample sizes of studies that mentioned the respective complications. The authors report no conflicts of interest directly or indirectly related to this work, and have not received any funds in support of this work. Results A total of 2232 articles were identified. Following screening of title, abstract, and full text availability, 63 articles were included in the review. There were a total 6819 patients with 11325 levels fused. The rate of complications for the categories included were as follows: wound (1.38%; 95% confidence interval CI=1.00-1.85%), cardiac (1.86%; CI=1.33-2.52%), vascular (0.81%; CI=0.44-1.36%), pulmonary (1.47; CI=0.95-2.16%), gastrointestinal (1.38%; CI=1.00-1.87%), urologic (0.93%; CI=0.55-1.47%), transient neurologic (36.07%; CI=34.74-37.41%), persistent neurologic (3.98%; CI=3.42-4.60%), and MSK/Spine (9.22%; CI=8.28-10.23%). Concluson The current study is the first to comprehensively analyze the complication profile for LLIFs. The most significant reported complications were transient neurologic in nature. However, persistent neurologic complications occurred at a much lower rate, bringing into question the significance of transient symptoms beyond the immediate postoperative period. Through this analysis of complication profiles, surgeons can better understand the risks and expectations for patients following LLIF procedures.
Structured Abstract Background Context Cervical disc arthroplasty (CDA) is an emerging technique for the treatment of cervical degenerative disease. Multiple studies have investigated the outcomes of ...CDA, particularly in comparison to cervical arthrodesis techniques such as anterior cervical discectomy and fusion (ACDF). As many entities have financial interests in CDA implants, it is imperative to consider the influence of conflicts of interest on the results of studies investigating the efficacy of CDA. Purpose To determine if there is an association between the presence of conflicts of interest amongst study authors and the reported outcome of studies involving CDA. Study design Systematic review of clinical CDA publications until October 2016. Outcome measure: Presence of conflicts of interest, level of evidence, and outcome for all included studies. Methods PUBMED and MEDLINE databases were searched for articles presenting clinical, radiographic, and cost outcomes of CDA. Data extracted from each article included: title, authors, publication year, level of evidence, prosthesis type, number of operative levels, presence of conflicts of interest, and outcome. Conflicts of interest were determined by the presence of any conflicts for any author within manuscript disclosure sections or through open payments reporting. Outcomes of each study were graded as either favorable, unfavorable, or equivocal. The presence of conflicts of interest was tested for an association with the level of evidence and study outcome using Pearson's chi-square analysis, Fisher's exact test, or logistic regression for categorical variables. The authors report no conflicts of interest directly or indirectly related to this work, and have not received any funds in support of this work. Results 98 articles were included in this analysis. In total, 44.9% (44) of articles had the presence of a conflict of interest, while 55.1% (54) of articles did not. Conflicted studies were more likely to present level I evidence and less likely to present level IV evidence than non-conflicted studies (p<0.001). Furthermore, conflicted studies were more likely to report favorable outcomes after CDA than non-conflicted studies (90.9% vs. 74.1%, p=0.040). Conclusions The results of this study suggest that the majority of conflicted and non-conflicted studies report favorable results in patients undergoing CDA. However, conflicted studies were also more likely to report favorable outcomes compared to non-conflicted studies. Individual clinicians must critically review published studies for potential conflicts of interest before incorporating CDA into their practice.
