Increased vertebral exposure in anterior lumbar interbody fusion associated with venous injury and deep venous thrombosis

Ho, Vy T.; Martinez-Singh, Krishna; Colvard, Benjamin; Lee, Jason T.; Chandra, Venita

doi:10.1016/j.jvsv.2020.08.006

Cited by 6 publications

(4 citation statements)

References 11 publications

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“…Past studies have documented a variety of negative associations in terms of outcomes and complications for multilevel lumbar fusion procedures, reporting increased incidence of extended length of stay, postoperative deep venous thrombosis, and vascular injury. 7,12,13 From an operative standpoint, the "window" at both the L4-L5 and L5-S1 levels is typically defined by the borders of the vasculature (eg, iliac vein/artery or inferior vena cava/abdominal aorta) and smaller windows may require more aggressive retraction of key structures such as the common iliac vein, potentially placing patients at higher risk for vascular injury, especially at the L4-L5 level as compared with the L5-S1 level. 23,24 The levels of aortic bifurcation and iliocaval confluence are also key factors that may modulate the risks associated with both operative window and number of operative levels.…”

Section: Baseline Risk Factorsmentioning

confidence: 99%

“…Operations involving multiple levels of the spine and in particular the L4-L5 level have been implicated as higher risks for complications and increased blood loss. 7,[11][12][13] A range of other factors have been reported to increase risk including a history of prior abdominal surgery, 14 increased body mass index (BMI), 7 male sex, 7 and segmental instability. 11,13 With a large variability in potential risk factors for poorer operative outcomes, the aim of the current study is to provide an objective scoring system to determine the preoperative risk an ALIF presents for a given individual.…”

mentioning

confidence: 99%

“…Prior efforts have focused largely on nonanatomic factors associated with increased risk for patients undergoing ALIF procedures. Operations involving multiple levels of the spine and in particular the L4–L5 level have been implicated as higher risks for complications and increased blood loss 7,11–13. A range of other factors have been reported to increase risk including a history of prior abdominal surgery,14 increased body mass index (BMI),7 male sex,7 and segmental instability 11,13…”

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confidence: 99%

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Risk Assessment of Anterior Lumbar Interbody Fusion Access in Degenerative Spinal Conditions

Singh¹,

Elliot²,

Lynch³

et al. 2022

Clinical Spine Surgery: A Spine Publication

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Study Design: This was a retrospective cohort study. Objective: Develop an evidence-based preoperative risk assessment scoring system for patients undergoing anterior lumbar interbody fusion (ALIF). Summary of Background Data: ALIF may hold advantages over other fusion techniques in sagittal restoration and fusion rates, though it introduces unique risks to vascular and abdominal structures and thus possibly increased risk of operative morbidity. Methods: Primary, 1 or 2-level ALIFs were identified in a surgical registry. Baseline characteristics were recorded. Axial magnetic resonance imagings at L4–L5 and L5–S1 were reviewed for vascular confluence/bifurcation or anomalous structures, and measured for operative window size/slope. To assess favorable outcomes, a clinical grade was calculated: (clinical grade=blood loss×operative duration), higher value indicating poorer outcome. To establish a risk scoring system, a base risk score algorithm was established and stratified into 5 categories: high, high to intermediate, intermediate, intermediate to low, and low. Modifiers to base risk score included age, body mass index, operative level, history of bone morphogenic protein use, calcified vasculature, spondylolisthesis grade, working window size and slope, and abnormal vasculature. Modifiers were weighted for contribution to surgical risk. A total risk score was calculated and evaluated for strength of association with clinical outcome grades by Pearson correlation coefficient. Results: A total of 65 patients were included. Mean clinical outcome grade was 5.6, mean total risk score 21.3±21.5. Multilevel procedures (L4–S1) mean total risk score was 57.3±7.8. L4–L5 mean total risk score was 23.6±5.2; L5–S1 mean total risk score 8.3±6.6. Correlation analysis demonstrated a significant and strong relationship (|r|=0.753; P<0.001) between total risk scores and clinical outcome grades. Conclusion: Calculated ALIF risk scores significantly correlated with operative duration and blood loss. This scoring system represents a potential framework to facilitate clinical decision-making and risk assessment for potential ALIF candidates with degenerative spinal pathologies.

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Section: Baseline Risk Factorsmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

See 1 more Smart Citation

Risk Assessment of Anterior Lumbar Interbody Fusion Access in Degenerative Spinal Conditions

Singh¹,

Elliot²,

Lynch³

et al. 2022

Clinical Spine Surgery: A Spine Publication

View full text Add to dashboard Cite

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“…The draping of the left common iliac vein around migrated hardware is a common finding that makes the dissection of the vessel difficult due to the scar formation, which limits the vessel mobilization. This is the case where the preoperative placement of stent graft within the left CIV could overcome the possibility of major hemorrhage intraoperative leading to acute occlusion of the left CIV and increased morbidity [ 17 - 18 ].…”

Section: Reviewmentioning

confidence: 99%

Vascular Injury in Elective Anterior Surgery of the Lumbar Spine: A Narrative Review

Pappa¹,

Evangelopoulos²,

Benetos³

et al. 2021

Cureus

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The incidence of anterior lumbar surgery is increasing as the population is aging. Although adverse events regarding vasculature injury are uncommon, several have been described in the current literature. Complications can be categorized based on the time of occurrence, more specifically intraoperative or postoperative, but also regarding the nature of vascular damage such as thrombosis, occlusion, or rupture. The rate of complications is higher in the setting of revision anterior surgery than with primary anterior lumbar surgery. Moreover, the incidence of revision anterior surgery is also increasing in contrast to the past. Through this narrative review, an effort is made for a thorough understanding of the complications associated with anterior lumbar surgery, which will aid in the prevention, recognition, and management of this rare complication.

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Anterior Lumbar Interbody Fusion in Spondylolisthesis

et al. 2023

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Increased vertebral exposure in anterior lumbar interbody fusion associated with venous injury and deep venous thrombosis

Cited by 6 publications

References 11 publications

Risk Assessment of Anterior Lumbar Interbody Fusion Access in Degenerative Spinal Conditions

Risk Assessment of Anterior Lumbar Interbody Fusion Access in Degenerative Spinal Conditions

Vascular Injury in Elective Anterior Surgery of the Lumbar Spine: A Narrative Review

Anterior Lumbar Interbody Fusion in Spondylolisthesis

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