Access related complications in anterior lumbar surgery performed by spinal surgeons

Abstract

We report a very thorough and critical review of our anterior lumbar access surgeries performed mostly for DDD and spondylolisthesis at L4/5 and L5/S1 levels. Vascular problems of any type (24/304, 7.8 %) were the most common complication during this approach. The incidence of major venous injury requiring repair was 14/304 (4.6 %) and arterial injury 5/304 (1.6 %). The requirement for a vascular surgeon with the vascular injury was 9/304 (3 %; 5 arterial injuries; 4 venous injuries). This also suggests that the majority of the major venous injuries were repaired by the spinal surgeon (10/14, 71 %). Our results are comparable to other studies and support the notion that anterior access surgery to the lumbar spine can be performed safely by spinal surgeons. With adequate training, spinal surgeons are capable of performing this approach without direct vascular support, but they should be available if required.

Access-related complications in anterior lumbar surgery in patients over 60 years of age

“…Apart from the vascular injuries, the only complication with a potential harm to the patient was a pulmonary embolism in a patient who had a venous injury, which was postoperatively managed with anticoagulation. In a recently published study, the overall complication rate in a younger patient population was 20 % [7]. While it has been reported that anterior access to the lumbar spine is associated with a risk of vascular injury, the reported rates of injury are reasonably low with or without a vascular access surgeon [6,7].…”

“…Particular attention was given to document all accessrelated intraoperative complications such as vascular injury, injury to ureter or kidney, bowel injury, and incidental opening of peritoneum, neurological injury, dural tear as well as anaesthetic complications such as problems with airway management or intraoperative circulatory problems. Vascular injury was defined as major if it required repair or reconstruction as previously defined [6,7]. Minor vascular injuries such as bleeding while mobilizing the vessels or ligating the iliolumbar vein that were treated with pressure or a haemostatic agent were not recorded in this study.…”

“…1 This shows an example of four-level ALIF and second-stage posterior instrumentation for a sagittal deformity. The restoration of lumbar lordosis was largely achieved by anterior release and cage placement acceptable complication rates [6,7]. Anecdotally, however, it has been suggested that the risk for intraoperative complications is higher in an elderly population in whom anterior access should be indicated with caution.…”

Preliminary Clinical and Radiographic Outcomes of Anterior Lumbar Interbody Fusion (ALIF) with stand alone PEEK cage and Anterior Plate Construct at the Bangkok Spine Academy

“…Quraishi and his team studied 304 patients in England nding that there are 4.6% venous injuries that needed to be repaired and 1.6% arterial injuries. 22 Brau and his team found in 1,315 patients 0.5% arterial injuries and 1.4% venous injuries. There are a lot more reports about this risk.…”

“…Despite it being an anterior surgery through the retroperitoneum, adjacent organs and blood vessels could be endangered. 22,23 Therefore, professional experience is needed for operating the intervertebral disc area close to arteries and veins. Quraishi and his team studied 304 patients in England nding that there are 4.6% venous injuries that needed to be repaired and 1.6% arterial injuries.…”