Few data are available to evaluate approach-related differences in perioperative complications with lumbar interbody fusion devices. Complications occurring in the intraoperative and immediate postoperative period were identified and categorized for 31 consecutive posterior lumbar interbody fusions (PLIFs) and 88 consecutive anterior lumbar interbody fusions (ALIFs). In this study, all lumbar interbody fusions were conducted with threaded cylindrical devices as stand-alone internal fixation devices. Multivariate analysis was used to account for potential covariates and identify factors associated with an increased complication risk. Twenty-two percent of the patients had a perioperative complication. The relative risk of having a perioperative complication was 4.75 times higher for the PLIF group. All intraoperative complications occurred in the PLIF group. The relative risk of having a major postoperative complication was 6.8 times higher in the PLIF group than the ALIF group. Anterior approached patients tended to have visceral (ileus, 6%) and vascular (deep venous thrombosis, 2%) complications. In the posterior group, complications were neurologic and dura related (pseudomeningocele, 16%; epidural hematoma, 3%) and occurred most frequently in patients that had had previous posterior lumbar surgery (31% with major complication).