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Philipp Bernhard Poppenborg, Ulf Liljenqvist, Georg Gosheger, Albert Schulze Bövingloh, Lukas Peter Lampe, Sebastian Schmeil, Tobias Schulte, Tobias Lange

• \(\bf Purpose\)  Transforaminal lumbar interbody fusion (TLIF) is a widely accepted surgical procedure for degenerative disk disease. While numerous studies have analyzed complication rates and risk factors this study investigates the extent to which complications after TLIF spondylodesis alter the clinical outcome regarding pain and physical function. \(\bf Methods\) A prospective clinical two-center study was conducted, including 157 patients undergoing TLIF spondylodesis with 12-month follow-up (FU). Our study classified complications into three subgroups: none (I), minor (IIa), and major complications (IIb). Complications were considered "major" if revision surgery was required or new permanent physical impairment ensued. Clinical outcome was assessed using visual analog scales for back (VAS-B) and leg pain (VAS-L), and Oswestry Disability Index (ODI). \(\bf Results\) Thirty-nine of 157 patients (24.8%) had at least one complication during follow-up. At FU, significant improvement was seen for group I (\(\it n\) = 118) in VAS-B (–50%), VAS-L (–54%), and ODI (–48%) and for group IIa (\(\it n\) = 27) in VAS-B (–40%), VAS-L (–64%), and ODI (–47%). In group IIb (\(\it n\) = 12), VAS-B (–22%, \(\it P\) = 0.089) and ODI (–33%, \(\it P\) = 0.056) improved not significantly, while VAS-L dropped significantly less (–32%, \(\it P\) = 0.013) compared to both other groups. \(\bf Conclusion\) Our results suggest that major complications with need of revision surgery after TLIF spondylodesis lead to a significantly worse clinical outcome (VAS-B, VAS-L, and ODI) compared to no or minor complications. It is therefore vitally important to raise the surgeon´s awareness of consequences of major complications, and the topic should be given high priority in clinical work.