The Surgical and Medical Perioperative Complications of Anterior Spinal Fusion Surgery in the Thoracic and Lumbar Spine in Adults

Faciszewski, Tom; Winter, Robert B.; Lonstein, John E.; Denis, Francis; Johnson, Linda

doi:10.1097/00007632-199507150-00007

Cited by 501 publications

(276 citation statements)

References 0 publications

Supporting

Mentioning

237

Contrasting

Unclassified

Order By: Relevance

“…Our transmuscular approach may have contributed to a slight increase of postoperative retroperitoneal hematomas. Our overall infection risk of 0.62% is comparable to those reported for the midline or extreme lateral access routes of 0% to 6% [5,12,15,24,32,34,[39][40][41]. With respect to previous studies on the oblique psoas-sparing approach, in the largest series of 179 patients, Silvestre et al [44] did not report on the general risk of infection and hematoma.…”

Section: Discussionsupporting

confidence: 62%

“…Anterior lumbar fusion techniques are an integral part of spine surgery, but anterior approaches to the lumbar spine are associated with a high risk of vascular complications, particularly at L4-L5 and above, and with the midline approaches [7,12,39]. To reduce risk of vascular injury, lateral approaches have been established [28,29].…”

Section: Discussionmentioning

confidence: 99%

“…Conversely, the risks of neurologic complications were less frequent in anterior lumbar interbody fusion procedures. Faciszewski et al [12] reported a 0.10% risk of injury of the lumbar plexus (one of 930 patients) and in 0.43% postsympathectomy syndromes (four of 930 patients).…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

The Oblique Anterolateral Approach to the Lumbar Spine Provides Access to the Lumbar Spine With Few Early Complications

Mehren

Mayer

Zandanell

et al. 2016

Clinical Orthopaedics &Amp; Related Research

133

View full text Add to dashboard Cite

Background During the last 20 years several less-invasive anterior approaches to the lumbar spine have become standard, including the extreme lateral transpsoas approach. Although it is associated with a lower risk of vascular injury compared with anterior midline approaches, neuromonitoring is considered mandatory to avoid neurologic complications. Interestingly, despite neuromonitoring, the reported risk of neurologic deficits with the extreme lateral transpsoas approach is greater than observed with other anterior approaches. An alternative lateral, oblique, psoassparing approach, recently named the oblique lumbar interbody fusion, uses the anatomic pathway between the abdominal vessels anteriorly and the lumbar plexus laterally to decrease the risk of neurologic and vascular injury; however, as yet, little on this new approach has been reported. Questions/purposesWe asked: what proportion of patients experienced (1) perioperative complications (overall complications), (2) vascular complications, and (3) neurologic complications after less-invasive anterior lumbar interbody fusion through the oblique lumbar interbody approach at one high-volume center? Methods We performed a chart review of intra-and perioperative complications of all patients who had undergone minimally invasive anterior lumbar interbody fusion through a lateral psoas-sparing approach from L1 to L5 during a 12-year period (1998)(1999)(2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010). During the study period, the oblique, psoas-sparing approach was the preferred approach of the participating surgeons in this study, and it was performed in 812 patients, all of whom are studied here, and all of whom have complete data for assessment of the short-term (inpatient-only) complications that we studied. In general, we performed this approach whenever possible, although it generally was avoided when a patient previously had undergone an open retro-or transperitoneal abdominal procedure, or previous implantation of hernia mesh in the abdomen. During the study period, posterior fusion techniques were used in an additional 573 patients instead of the oblique lumbar interbody fusion when we needed to decompress the spinal canal beyond what is possible through the anterior approach. In case of spinal stenosis calling for fusion in combination with a high disc space, severe endplate irregularity, or severe biomechanical instability, we combined posterior decompression with oblique lumbar interbody fusion in 367 patients. Complications were evaluated by an independent observer who was not involved in the decisionmaking process, the operative procedure, nor the Each author certifies that he or a member of his immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research 1 ed...

show abstract

Section: Discussionsupporting

confidence: 62%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

The Oblique Anterolateral Approach to the Lumbar Spine Provides Access to the Lumbar Spine With Few Early Complications

Mehren

Mayer

Zandanell

et al. 2016

Clinical Orthopaedics &Amp; Related Research

133

View full text Add to dashboard Cite

show abstract

“…In trauma patients conventional open approaches are generally related to significant morbidity due to increased infection rate, high blood loss and approach related morbidity (muscle morbidity as denervation, revascularization damage, increased intramuscular pressures, etc. [21][22][23]). This increased morbidity associated to the difficult hemodynamic management and the possible ventilatory/perfusion mismatch in the first 48 h in polytrauma patients led, generally, to delay surgery.…”

Section: Discussionmentioning

confidence: 99%

Percutaneous pedicle screw fixation in polytrauma patients

Scaramuzzo

Tamburrelli²,

Piervincenzi

et al. 2013

Eur Spine J

View full text Add to dashboard Cite

“…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%

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

View full text Add to dashboard Cite

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.

show abstract

The Surgical and Medical Perioperative Complications of Anterior Spinal Fusion Surgery in the Thoracic and Lumbar Spine in Adults

Cited by 501 publications

References 0 publications

The Oblique Anterolateral Approach to the Lumbar Spine Provides Access to the Lumbar Spine With Few Early Complications

The Oblique Anterolateral Approach to the Lumbar Spine Provides Access to the Lumbar Spine With Few Early Complications

Percutaneous pedicle screw fixation in polytrauma patients

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

Contact Info

Product

Resources

About