ETDIF Risks and Complications

For minimally invasive ETDIF, short-term and medium-term recovery is generally quicker than in open surgery, but both types of surgery have similar long-term results.1,2

Many of the risks involved in this type of surgery are similar to risks of any type of fusion. As an overall observation, the ETDIF procedure is a newer type of surgery so there are relatively more unknowns and less medical literature compared to an open ETDIF.

ETDIF Potential Risks

One risk of any type of fusion is pseudarthrosis, in which bone growth is not sufficient to form a solid fusion. This occurs more commonly in patients with certain personal risk factors; for example, anyone who smokes cigarettes, or who has any form of nicotine intake, is at risk for a nonunion because nicotine hampers bone growth.

Other risks include, but are not limited to:

  • Infection
  • Bleeding
  • Pain at the site of the bone graft
  • Recurring symptoms 
  • Nerve damage 
  • Blood clots

See Spinal Fusion Surgery Recovery: 1 to 4 Weeks After


Some minimally invasive procedures are relatively new and pose considerable technical challenges. As a general rule, for surgery more experience usually leads to better results, so finding a surgeon with extensive experience in transforaminal lumbar endoscopic interbody fusion is advised.

See Guidelines for Evaluating a Spine Surgeon

The ETDIF technology may mean the surgery will take a shorter amount of time than open surgery, but there may be additional exposure to radiation from the equipment used.

In addition, with minimally invasive approaches there may be an increased probability of using synthetic bone morphogenic protein (BMP), instead of the patient's own bone, to set up the fusion. There are potential unique risks with using BMP.


Overall, there is limited scientific study comparing the results and risks of a minimally invasive / endoscopic approach to ETDIF versus the open surgical approach. The success of each approach has a lot to do with the individual surgeon's experience and preferences.


  • 1.Yang Y, Liu B, Rong LM, et al. Microendoscopy-assisted minimally invasive transforaminal lumbar interbody fusion for lumbar degenerative disease: short-term and medium-term outcomes. Int J Clin Exp Med. 2015;8(11):21319-26.
  • 2.Lee KH, Yue WM, Yeo W, Soeharno H, Tan SB. Clinical and radiological outcomes of open versus minimally invasive transforaminal lumbar interbody fusion. Eur Spine J. 2012;21(11):2265-70.