Factors Associated With Reoperation After Minimally Invasive Tubular Transforaminal Lumbar Interbody Fusion: A Cohort Study of 756 Patients

Abstract

Study Design Retrospective Cohort Study using Nested Matched Case-Control Analysis. Objectives High-volume data to describe the complication profile and factors associated with reoperation after minimally invasive tubular transforaminal lumbar interbody fusions (TLIFs) in the short-term (<30 days) and long-term (>30 days). Methods All tubular TLIFs (2011-2024) were retrospectively reviewed, performed by eight neurosurgeons at our single centre. Two matched controls per reoperation case were manually selected. Each control had undergone the same primary procedure within six months of the index case, at the same levels and, if possible, by the same surgeon. Variables included demographics, comorbidities, frailty indices, private/public status, workplace injury, preoperative antithrombotics, preoperative laboratory results, the symptomatic indications, surgical factors, and clinical outcomes. Univariate logistic regression identified candidate variables for multivariate analysis. Results From 756 patients, there was a 6.6% reoperation rate (n=50), with mean follow-up of 1.5 (±1.7) years. Short-term reoperation was predominantly for cage migration and multivariate analysis revealed no independent predictors. Long-term reoperation was mainly for cage migration and was associated with private-funding, WorkCover status, osteoporosis/osteopenia, and previous lumbar surgery. Combined timeframe reoperations were associated with WorkCover status, osteoporosis/osteopenia, diabetes, and previous lumbar surgery. Patients who had reoperations fared worse than their matched controls. Additionally, a worse patient outcome was associated with diabetes, a higher Modified Charlson Comorbidity Index, and previous lumbar surgery. Conclusion This retrospective case-control series reports our complication profile and factors associated with reoperation and poor patient outcomes after tubular TLIFs. Reoperation was associated with osteoporosis/osteopenia, diabetes, private-funding, WorkCover status, and previous lumbar surgery at another spinal level.