Effects of Prior Abdominal Surgery, Obesity, and Lumbar Spine Level on Anterior Retroperitoneal Exposure of the Lumbar Spine

Mogannam, Abid; Bianchi, Christian; Chiriano, Jason; Patel, Sheela T.; Teruya, Theodore H.; Lum, Sharon S.; Abou-Zamzam, Ahmed M.

doi:10.1001/archsurg.2012.1148

Cited by 24 publications

(14 citation statements)

References 22 publications

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Section: Anatomy and Physiology Of The Intervertebral Diskmentioning

confidence: 99%

“…Mogannam et al reviewed 476 patients who underwent anterior retroperitoneal exposure of the lumbar spine and found that more perioperative complications occurred in patients with larger BMI. 106 These included higher rates of vascular injury and overall complications, such as bowel and ureteral injuries, postoperative ileus, neurologic deficit, and cardiopulmonary and wound issues. In a cohort of 1,190 patients undergoing treatment for lumbar disk herniation, Rihn et al showed that obese patients (BMI > 30) required significantly longer operation times and had more blood loss and increased length of stay.…”

Section: Anatomy and Physiology Of The Intervertebral Diskmentioning

confidence: 99%

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Disk Degeneration and Low Back Pain: Are They Fat-Related Conditions?

Samartzis

Karppinen

Cheung

et al. 2013

Global Spine Journal

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Low back pain (LBP) is the world's most debilitating condition. Disk degeneration has been regarded as a strong determinant associated with LBP. Overweight and obesity are public health concerns that affect every population worldwide and whose prevalence continues to rise. Studies have indicated strong associations between overweight/obesity and disk degeneration as well as with LBP. This broad narrative review article addresses the various mechanisms that may be involved leading to disk degeneration and/or LBP in the setting of overweight/obesity. In particular, our goal is to raise awareness of the role of fat cells and their involvement via altered metabolism or the release of adipokines as well as other pathways that may lead to the development of disk degeneration and LBP. Understanding the role of fat in this process may aid in the development of novel biological therapies and technologies to halt the progression or regenerate the disk. Moreover, with genetic advancements and the appreciation of genetic epidemiology, a more personalized approach to spine care may have to consider the role of fat in any preventative, therapeutic, and/or prognosis modalities toward the disk and LBP.

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Section: Anatomy and Physiology Of The Intervertebral Diskmentioning

confidence: 99%

Section: Anatomy and Physiology Of The Intervertebral Diskmentioning

confidence: 99%

Disk Degeneration and Low Back Pain: Are They Fat-Related Conditions?

Samartzis

Karppinen

Cheung

et al. 2013

Global Spine Journal

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“…Nourian et al noted major venous injuries in 4.6% of cases and major arterial injuries in 1.6% [ 5 ]. When minor injuries are included, the historical rate of vascular injury exceeds 10% [ 6 , 7 , 8 ]. The use of the minimally invasive retractor allows for a lateral exposure to the spinal column, thus avoiding potential hazards of iliac vessels when performing more anterior exposures.…”

Section: Discussionmentioning

confidence: 99%

Fewer Cardiopulmonary Complications and Shorter Length of Stay in Anterolateral Thoracolumbar Spine Exposures Using a Small-Incision Specialized Retractor System

Khan-Makoid

Tjaden

Leake

et al. 2020

JCM

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Objectives: One of the challenges of spine surgery is the need for adequate exposure of the anterolateral spinal column. Improved retractor systems with integrated lighting minimize the need for large thoracotomy, flank, or abdominal incisions. In 2013, we began using the NuVasive MaXcess® system via a minimal-access lateral incision for thoracic and thoracolumbar spine exposures. These small-access approaches may not offer adequate exposure when bleeding and other complications arise. We sought to determine the feasibility and outcomes of a minimal-access retractor during anterolateral spine exposures. Methods: An institutional-review-board-approved retrospective chart review was performed of all patients who underwent anterolateral thoracic and lumbosacral spine exposure at an academic hospital between December 1999 and April 2017. Cervical and posterior spine exposures were not included. Information regarding patient demographics, comorbid conditions, operative techniques, exposure, estimated blood loss, length of stay, and intraoperative and postoperative complications was collected. Data for standard exposure vs. minimally invasive exposures were compared. Results: Between December 1999 and April 2017, 223 anterolateral spinal exposures were performed at our institution. Of those, 122 (54.7%) patients had true lateral exposures, with 22 (18%) using the minimally invasive retractor. The mean age of our patient population was 57 years (19–89), with 65 (53%) men and a mean body mass index of 29.0 (17.4–58.6). In the standard exposure group, complications occurred in 22 (22%) patients, whereas only two (9%) complications occurred in the minimal-access group. There were no significant differences in overall intraoperative and postoperative complications, except for cardiopulmonary complications, which were reduced in the minimally invasive group (p < 0.019). Patients with minimally invasive exposure had a significantly shorter length of stay than those with standard exposure (7 vs. 13 days, p = 0.001). Conclusions: Minimal-access techniques using advanced retractor systems are both feasible and safe compared to standard techniques allowing for similar lateral spine exposure, but with smaller incisions, fewer cardiopulmonary complications, and shorter lengths of stay.

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“…The frequency of all-cause complications for anterior exposures has been reported to be between 40 and 50 per cent, 1,3 and, in one study, as high as 82 per cent. 15 Vascular injury is the most commonly reported complication, with published rates from 1 to 15 per cent. [2][3][4][5][6]11 Based on these rates, our 2.1 per cent incidence of major vascular injury is acceptable.…”

Section: Discussionmentioning

confidence: 99%

Incorporation of Anterior Lumbosacral Spine Exposure into a General Surgical Practice

Champney

Abuhakmeh

Chung

2017

The American Surgeon

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Many spine surgeons enlist the aid of an “access surgeon” to provide anterior exposure of the lumbosacral spine. We proposed that a single, community hospital general surgery practice can successfully develop an anterior spine exposure program with acceptable clinical outcomes. One hundred and forty-three consecutive anterior exposures were performed between 2008 and 2014. Morbidity and 30-day mortality were recorded. The effects of American Society of Anesthesiologists Physical Status classification (ASA class) and number of levels exposed on length of stay (LOS) and estimated blood loss (EBL) was reported. The growth of the program during this period was also evaluated. During the six-year period, there were nine (6.3%) major complications and 17 (11.9%) minor complications with no 30-day mortality. The mean LOS was similar for one-level and two-level exposures (3.8 days). Mean LOS was higher in ASA III patients (4.4 days) than ASA I (2.9 days) or ASA II (3.2 days). Mean EBL for one-level exposures (336.3 mL) was not significantly different than EBL for two-level exposures (425.9 mL). EBLs in ASA class III patients were greater than in class I and class II patients. The program began in July of 2008 with a single spine surgeon and one operation that year. A high of 54 procedures, with seven different spine surgeons, was recorded in 2013. A single, community hospital general surgery practice can successfully develop an anterior approach to spine exposure program with acceptable clinical outcomes and with sustained growth of the program.

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Effects of Prior Abdominal Surgery, Obesity, and Lumbar Spine Level on Anterior Retroperitoneal Exposure of the Lumbar Spine

Abstract: To evaluate the effects of prior abdominal surgery and obesity and the level of spine exposure on the technical aspects and complications of anterior retroperitoneal exposure of the lumbar spine (ARES).

Cited by 24 publications

References 22 publications

Disk Degeneration and Low Back Pain: Are They Fat-Related Conditions?

Disk Degeneration and Low Back Pain: Are They Fat-Related Conditions?

Fewer Cardiopulmonary Complications and Shorter Length of Stay in Anterolateral Thoracolumbar Spine Exposures Using a Small-Incision Specialized Retractor System

Incorporation of Anterior Lumbosacral Spine Exposure into a General Surgical Practice

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