Complications associated with posterior and transforaminal lumbar interbody fusion

J Am Acad Orthop Surg. 2012 May;20(5):283-91. doi: 10.5435/JAAOS-20-05-283.


Posterior lumbar interbody fusion and transforaminal lumbar interbody fusion are commonly performed to obtain a 360° arthrodesis through a posterior-only approach. These techniques are currently used in the management of spondylolisthesis, degenerative scoliosis, pseudarthrosis, recurrent disk herniation, and chronic low back pain with associated degenerative disk disease. Several adverse events have been described, including intraoperative neurologic injury, implant migration or subsidence, dural tears, infection, heterotopic ossification, BMP-related radiculitis, and osteolysis. Although the use of newer materials (eg, bone morphogenetic proteins) and procedures (eg, minimally invasive surgery) is on the rise, they are associated with unique concerns. Understanding the potential adverse events and steps that can be taken to prevent, detect, and manage complications is critical in patient counseling and perioperative decision making.

Publication types

  • Review

MeSH terms

  • Bone Morphogenetic Protein 2 / adverse effects
  • Dura Mater / injuries
  • Humans
  • Lumbar Vertebrae / surgery*
  • Lumbosacral Plexus / injuries
  • Minimally Invasive Surgical Procedures / adverse effects
  • Ossification, Heterotopic / chemically induced
  • Osteolysis / chemically induced
  • Prosthesis Failure
  • Radiculopathy / etiology
  • Recombinant Proteins / adverse effects
  • Spinal Diseases / surgery*
  • Spinal Fusion / adverse effects*
  • Surgical Wound Infection / etiology


  • Bone Morphogenetic Protein 2
  • Recombinant Proteins