Need of vascular surgeon and comparison of value for anterior lumbar interbody fusion (ALIF) in lateral decubitus: Delphi consensus

Menezes, Cristiano Magalhães; Alamin, Todd F.; Amaral, Rodrigo; Carvalho, Alexandry Dias; Díaz, Roberto; Guiroy, Alfredo; Lam, Khai S.; Lamartina, Claudio; Perez-Contreras, Alberto; Rivera-Colon, Yamil; Smith, Willian; Taboada, Néstor; Timothy, Jake; Langella, Francesco; Berjano, Pedro

doi:10.1007/s00586-022-07319-3

Cited by 3 publications

(1 citation statement)

References 21 publications

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“…[ 3 4 5 6 7 8 ] Multiple studies have evaluated the incidence and types of complications in ALIF with and without the use of access surgeons. [ 4 9 10 11 12 ] Overall, there is varied support in the literature for general/vascular assistance with anterior-based approaches to the spine. [ 4 10 11 13 14 15 ] Other approaches to the spine utilize access surgeons less frequently but are not without their own risks.…”

Section: Introductionmentioning

confidence: 99%

Lateral approach to the lumbar spine: The utility of an access surgeon

Lee,

Meade,

Brush

et al. 2023

J Craniovert Jun Spine

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Background: Lateral lumbar interbody fusions (LLIFs) utilize a retroperitoneal approach that avoids the intraperitoneal organs and manipulation of the anterior vasculature encountered in anterior approaches to the lumbar spine. The approach was championed by spinal surgeons; however, general/vasculature surgeons may be more comfortable with the approach. Objective: The objective of this study was to compare short-term outcomes following LLIF procedures based on whether a spine surgeon or access surgeon performed the approach. Materials and Methods: We retrospectively identified all one- to two-level LLIFs at a tertiary care center from 2011 to 2021 for degenerative spine disease. Patients were divided into groups based on whether a spine surgeon or general surgeon performed the surgical approach. The electronic medical record was reviewed for hospital readmissions and complication rates. Results: We identified 239 patients; of which 177 had approaches performed by spine surgeons and 62 by general surgeons. The spine surgeon group had fewer levels with posterior instrumentation (1.40 vs. 2.00; P < 0.001) and decompressed (0.94 vs. 1.25, P = 0.046); however, the two groups had a similar amount of two-level LLIFs (29.9% vs. 27.4%, P = 0.831). This spine surgeon approach group was found to have shorter surgeries (281 vs. 328 min, P = 0.002) and shorter hospital stays Length of Stay (LOS) (3.1 vs. 3.6 days, P = 0.019); however, these differences were largely attributed to the shorter posterior fusion construct. On regression analysis, there was no statistical difference in postoperative complication rates whether or not an access surgeon was utilized ( P = 0.226). Conclusion: Similar outcomes may be seen regardless of whether a spine or access surgeon performs the approach for an LLIF.

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Section: Introductionmentioning

confidence: 99%

Lateral approach to the lumbar spine: The utility of an access surgeon

Lee,

Meade,

Brush

et al. 2023

J Craniovert Jun Spine

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The anatomical feasibility of anterior intra- and extra-bifurcation approaches to L5-S1: an anatomic study based on lumbar MRI

gong¹,

Zhu²,

Wei³

et al. 2023

The Spine Journal

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An Update in Complication Rates Associated With Anterior Lumbar Surgery: A Systematic Review and Meta-Analysis

Issa,

Ezeonu,

Sellig

et al. 2024

Global Spine Journal

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Study Design Systematic Review and meta-analysis. Objective To conduct an updated systematic review and meta-analysis of complications associated with different anterior fusion techniques/approaches and adjuvant resources (i.e., computed tomography angiography (CTA), rhBMP-2, and access surgeons). Methods A systematic review was conducted from 1/1/2014-4/1/2024 for studies evaluating the incidence of complications associated with anterior lumbar procedures. Comparisons of complications were made between surgical approach, use of CTA, rhBMP-2, and access surgeons. Meta-analyses were conducted using a generalized linear mixed model. Results 54 studies were included in the final analysis with 8066 patients and an average follow-up of 31.2 months. The overall complication rate associated with anterior lumbar surgery was 13.1%, including an intraoperative complication rate of 3.8%, postoperative complication rate of 7.4%, infection rate of 1.5%, and reoperation rate of 1.7%. Forest plot analysis showed no significant difference in overall complication rates between open and mini-open techniques, although mini-open techniques were associated with lower overall reoperation rates. The use of CTA was associated with an increase in intraoperative and overall complications, and the use of an access surgeon was associated with a decreased risk of reoperation. The use of rhBMP-2 was not associated with overall complication risk. Conclusions While anterior lumbar surgery provides numerous benefits, surgeons and patients alike should be aware of the complication and safety profile prior to surgery. High quality studies are warranted to help elucidate the true benefit of certain techniques and adjuvant resources in reducing complications.

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Need of vascular surgeon and comparison of value for anterior lumbar interbody fusion (ALIF) in lateral decubitus: Delphi consensus

Cited by 3 publications

References 21 publications

Lateral approach to the lumbar spine: The utility of an access surgeon

Lateral approach to the lumbar spine: The utility of an access surgeon

The anatomical feasibility of anterior intra- and extra-bifurcation approaches to L5-S1: an anatomic study based on lumbar MRI

An Update in Complication Rates Associated With Anterior Lumbar Surgery: A Systematic Review and Meta-Analysis

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