Analysis of Operative Complications in a Series of 471 Anterior Lumbar Interbody Fusion Procedures

Sasso, Rick C.; Best, Natalie M.; Mummaneni, Praveen V.; Reilly, Thomas M.; Hussain, Sajjad

doi:10.1097/01.brs.0000155423.18218.75

Cited by 172 publications

(111 citation statements)

References 30 publications

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“…Complications associated with these traditional open spine fusion procedures have been described and include visceral injury and neurologic deficits. By virtue of the newer lateral transpsoas approach to the lumbar spine, an access surgeon is not necessary and the need to mobilize the great vessels is obviated, which minimizes the potential for visceral and vascular complications [4,10,22,26]. This advantage has been realized, with a recent clinical report of a zero incidence of intraoperative visceral injury [20].…”

Section: Discussionmentioning

confidence: 99%

Indirect Decompression of Lumbar Stenosis With Transpsoas Interbody Cages and Percutaneous Posterior Instrumentation

Castellvi

Nienke

Marulanda

et al. 2014

Clinical Orthopaedics &Amp; Related Research

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Background The minimally invasive lateral transpsoas retroperitoneal approach to address lumbar stenosis offers advantages to traditional approaches, including sparing of the AP annulus and longitudinal ligament and less risk to the peritoneal contents and retroperitoneal vascular structures. Few studies have presented longitudinal measures of radiographic indirect decompression and relief of pain and restoration of function using the lateral approach to spine fusion. Question/purposes We determined (1) whether radiographic measures suggestive of decompression were achieved after surgery and maintained 1 year after surgery, (2) whether the intervention resulted in sustained improvements in patient-reported outcomes scores 1 year after surgery, and (3) the frequency of pseudarthrosis on CT scans at 1 year after surgery in patients with moderate or severe lumbar stenosis treated with the approach. Methods Between 2008 and 2012, 158 patients were surgically treated to alleviate symptoms associated with degenerative lumbar stenosis, of whom 60 (38%) were treated with lateral lumbar interbody fusion. Of these 60 patients, 36 (60%) received CT scans preoperatively and at 1-year postoperatively and were available for radiographic analysis. Of the 60 treated patients, 16 (27%) were lost to followup before 12 months, leaving the records of 44 patients available for review of patient-reported improvements in pain and return to function. Radiographic increases in disc height, foraminal area, and canal area were measured by one observer on CT scans postoperatively and at 1 year and compared to preoperative values. Patient-reported scores, including VAS pain score and Oswestry Disability Index (ODI), were collected preoperatively and at 3 and 12 months postoperatively.

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Section: Discussionmentioning

confidence: 99%

Indirect Decompression of Lumbar Stenosis With Transpsoas Interbody Cages and Percutaneous Posterior Instrumentation

Castellvi

Nienke

Marulanda

et al. 2014

Clinical Orthopaedics &Amp; Related Research

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“…The formation of adhesions after the primary surgery increases the potential for iatrogenic injury during the revision exposure [12]. If complications related to anterior exposure of the lumbar spine in primary surgeries have been well reported in the literature [1,5,19], only a few studies have reported the technical difficulties and the complications associated with revision surgeries through an anterior approach [2,9,11,[13][14][15][16][17].…”

Section: Discussionmentioning

confidence: 99%

“…The complications associated with the anterior approach to the lower lumbar spine are summarized in Table 1. The incidence of vascular injury is estimated at 1.9-8 %, with the greatest risk at the L4-L5 level [3][4][5]. Ureteral injury during anterior lumbar arthrodesis has been reported in only a small number of cases [3,[5][6][7][8][9][10][11].…”

Section: Introductionmentioning

confidence: 99%

Analysis of intraoperative difficulties and management of operative complications in revision anterior exposure of the lumbar spine: a report of 25 consecutive cases

et al. 2012

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Purpose After a first anterior approach to the lumbar spine, formation of adhesions of soft tissues to the spine increases the surgical difficulties and potential for iatrogenic injury during the revision exposure. The objective of this study was to identify the intraoperative difficulties and postoperative complications associated with revision anterior lumbar spine procedures in a single institution. Methods This is a retrospective review of 25 consecutive anterior revision lumbar surgeries in 22 patients (7 men and 15 women) operated on between 1998 and 2011. Patients with trauma or malignancies were excluded. The mean age of the patients at the time of revision surgery was 56 years (range 20-80 years). The complications were analyzed depending on the operative level and the time between the index surgery and the revision. Results Six major complications (five intraoperatively and one postoperatively) occurred in five patients (20 %): three vein lacerations (12 %) and two ureteral injuries (8 %), despite the presence of a double-J ureteral stent. The three vein damages were repaired or ligated by a vascular surgeon. One of the two ureteral injuries led to a secondary nephrectomy after end-to-end anastomosis failure; the other necessitated secondary laparotomy for small bowel obstruction. Conclusions Anterior revision of the lumbar spine is technically challenging and is associated with a high rate of vascular or urologic complications. Therefore, the potential complications of the procedure must be weighted against its benefits. When iterative anterior lumbar approach is mandatory, exposure should be performed by an access surgeon in specialized centers that have ready access to vascular and urologic surgeons.

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“…Traditionally, interbody arthrodesis is achieved through open surgical approaches, including anterior lumber interbody fusion (ALIF) [4,10,21,27,29,31], posterior lumbar interbody fusion (PLIF) [9], and transforaminal interbody fusion (TLIF) [8,18,24,27,35]. Several studies have documented the complications of these surgical techniques [1,5,11,23,30].…”

Section: Introductionmentioning

confidence: 99%

“…Anteriorapproach complications include damage to the abdominal organs (\ 1%), vascular injury (1.3%-15.6%), disruption of the sympathetic plexus (1.7%-13.3%), and postoperative ileus (0.6%-5.6%) [6,[29][30][31]. Posterior approaches avoid the aforementioned risks but can lead to soft tissue devitalization, nerve root injuries (9%-16%), postoperative radiculitis (6.7%-16.4%), and incidental durotomies (5.4%-10%) [5,9,26,31].…”

Section: Introductionmentioning

confidence: 99%

Complications of the Lateral Transpsoas Approach for Lumbar Interbody Arthrodesis: A Case Series and Literature Review

Sofianos

Briseño

Abrams

et al. 2012

Clinical Orthopaedics &Amp; Related Research

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Background The lateral transpsoas approach to the lumbar spine was developed to eliminate the need for an anterior-approach surgeon and retraction of the great vessels and has the potential for shorter operative times. However, the reported complications associated with this approach vary. Questions/purposes We identified the incidence of complications associated with the lateral transpsoas approach to the lumbar spine. Patients and Methods We retrospectively reviewed 45 patients who underwent a lateral transpsoas approach to the spine for various diagnoses between January 1, 2006, and October 31, 2010. The patients' average age was 63.3 years. Sixteen (35.6%) patients had prior lumbar spinal surgery.Twenty-one patients (46.7%) underwent supplemental posterior instrumentation. Minimum followup was 0 months (mean, 11 months; range, 0-34 months). Results Eighteen of the 45 patients (40%) had complications: 10 (22.2%) developed postoperative iliopsoas weakness, three had quadriceps weakness, and one experienced foot drop. Eight patients (17.8%) developed anterior thigh hypoesthesia, which did not fully resolve in seven of the eight patients at an average of 9 months' followup. Three patients had postoperative radiculopathies, one a durotomy, and one died postoperatively from a pulmonary embolism. Conclusions We found a 40% incidence of complications and a nontrivial frequency and severity of postoperative weakness, numbness, and radicular pain in patients who underwent a lateral transpsoas approach to the spine. Given the expanding use of the approach, a thorough understanding of the risks associated with it is essential for patient education, medical decision making, and identifying methods of reducing such complications.

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Analysis of Operative Complications in a Series of 471 Anterior Lumbar Interbody Fusion Procedures

Abstract: Placement of threaded devices, such as cages or bone dowels, was associated with a higher acute complication rate than was the placement of nonthreaded devices during anterior lumbar interbody fusion.

Cited by 172 publications

References 30 publications

Indirect Decompression of Lumbar Stenosis With Transpsoas Interbody Cages and Percutaneous Posterior Instrumentation

Indirect Decompression of Lumbar Stenosis With Transpsoas Interbody Cages and Percutaneous Posterior Instrumentation

Analysis of intraoperative difficulties and management of operative complications in revision anterior exposure of the lumbar spine: a report of 25 consecutive cases

Complications of the Lateral Transpsoas Approach for Lumbar Interbody Arthrodesis: A Case Series and Literature Review

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