Urogenital Complications of Anterior Approaches to the Lumbar Spine

Johnson, Rollin M.; McGuire, Edward J.

doi:10.1097/00003086-198101000-00017

Cited by 59 publications

(31 citation statements)

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“…A lowprofile instrumentation with a smooth surface can therefore be of advantage. Other serious risks of an anterior access to the spine should not be disregarded, including neurological complications [22,23,26,33,34,41], direct injury of the bowels [ 17], of the ureter [8] and postoperative scar stricture [1,5,6,45,57].…”

Section: Discussionmentioning

confidence: 99%

Primary stable anterior instrumentation or dorsoventral spondylodesis in spondylodiscitis?

Eysel¹,

Hopf²,

Vogel³

et al. 1997

Eur Spine J

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The operative results of 23 patients with a specific or unspecific spondylodiscitis were documented over 2 years after the focus of the inflammation had been eradicated, bone chip had been interposed and a CDH instrumentation had been performed by an anterior approach only. These outcomes were compared with the results of 32 patients in whom the focus had been removed and the defect had been filled with bone graft from an anterior approach, followed by stabilisation with CD instrumentation through an additional dorsal approach. In the cases where CDH instrumentation was applied, the range of fusion averaged 1.3 segments. This was clearly less extensive than in dorsoventral stabilisation, in which on average 3.5 segments were fused. In 47 of 55 cases mobilisation was achieved without orthesis. Eight months after the operations bony fusion could be observed radiologically in all patients. The mean preoperative kyphotic angle of the affected segments was 14.4 ° , compared to 4 ° after the operation. The mean loss of reposition was measured to be about 2.7 ° in both groups. Average operation time and blood loss were about 50% higher in the patients treated dorsoventrally. We conclude that even in the case of florid spondylodiscitis, a short-range anterior fusion of the affected spinal segment may be performed by use of a stableangle implant without an increased risk of infection-related loosening.

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Section: Discussionmentioning

confidence: 99%

Primary stable anterior instrumentation or dorsoventral spondylodesis in spondylodiscitis?

Eysel¹,

Hopf²,

Vogel³

et al. 1997

Eur Spine J

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“…1,2,5 Although sympathetic complications have been described after anterior approaches, they remain predominantly confined to reports of damage to the superior hypogastric plexus while approaching the L5-S1 disc space resulting in retrograde ejaculation. [1][2][3][4][5] The incidence of sympathetic damage after an anterior lumbar approach has been described to be as high as 45% in laparoscopic approaches to L5-S1. 5 Recent randomized United States Food and Drug Administration studies for artificial lumbar disc replacement and anterior lumbar fusion show a rate of 2% of retrograde ejaculation.…”

Section: Discussionmentioning

confidence: 99%

“…Retrograde ejaculation remains the most commonly described autonomic complication after anterior approaches to the lumbosacral spine and occurs while performing instrumentation/surgery at the L5-S1 level. [1][2][3][4][5] Sympathetic complications are considered rare after anterior approach for other lumbar levels. Although there are a few reports of postoperative temperature variation, dysesthesias, discoloration, and/or swelling of the lower limb, objective descriptions are very rare, especially after surgery at the L4-L5 level.…”

Section: Introductionmentioning

confidence: 99%

Anhidrosis after anterior retroperitoneal approach for L4–L5 artificial disc replacement

Kasliwal

Deutsch

2011

Journal of Clinical Neuroscience

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“…The patient was young and planned to have children in the future, which made the option of anterior lumbar interbody fusion less desirable because it can be associated with retrograde ejaculation. 19 In addition, segmental fusion in a young patient might accelerate the need for possible additional fusions in the future from adjacent-level disease. 9,12 Posterior interlaminar microdiscectomy would provide excellent symptomatic relief of radicular pain, but this comes at the cost of removal of the ligamentum flavum, medial facetectomy, and dissection of the paraspinal muscle, leading to worsening of the listhesis.…”

Section: Endoscopic Discectomy In Pars Defect and Spondylolisthesis Dmentioning

confidence: 99%

Transforaminal endoscopic discectomy to relieve sciatica and delay fusion in a 31-year-old man with pars defects and low-grade spondylolisthesis

Madhavan

Chieng

Hofstetter

et al. 2016

FOC

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Isthmic spondylolisthesis due to pars defects resulting from trauma or spondylolysis is not uncommon. Symptomatic patients with such pars defects are traditionally treated with a variety of fusion surgeries. The authors present a unique case in which such a patient was successfully treated with endoscopic discectomy without iatrogenic destabilization. A 31-year-old man presented with a history of left radicular leg pain along the distribution of the sciatic nerve. He had a disc herniation at L5/S1 and bilateral pars defects with a Grade I spondylolisthesis. Dynamic radiographic studies did not show significant movement of L-5 over S-1. The patient did not desire to have a fusion. After induction of local anesthesia, the patient underwent an awake transforaminal endoscopic discectomy via the extraforaminal approach, with decompression of the L-5 and S-1 nerve roots. His preoperative pain resolved immediately, and he was discharged home the same day. His preoperative Oswestry Disability Index score was 74, and postoperatively it was noted to be 8. At 2-year follow-up he continued to be symptom free, and no radiographic progression of the listhesis was noted. In this case preservation of stabilizing structures, including the supraspinous and interspinous ligaments and the facet capsule, may have reduced the likelihood of iatrogenic instability while at the same time achieving symptom control. This may be a reasonable option for select patient symptoms confined to lumbosacral radiculopathy.

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Urogenital Complications of Anterior Approaches to the Lumbar Spine

Cited by 59 publications

References 0 publications

Primary stable anterior instrumentation or dorsoventral spondylodesis in spondylodiscitis?

Primary stable anterior instrumentation or dorsoventral spondylodesis in spondylodiscitis?

Anhidrosis after anterior retroperitoneal approach for L4–L5 artificial disc replacement

Transforaminal endoscopic discectomy to relieve sciatica and delay fusion in a 31-year-old man with pars defects and low-grade spondylolisthesis

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