Vascular complications of exposure for anterior lumbar interbody fusion

Garg, Joy; Woo, Karen; Hirsch, Jodi; Bruffey, James D.; Dilley, Ralph B.

doi:10.1016/j.jvs.2009.11.039

Cited by 135 publications

(105 citation statements)

References 24 publications

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“…Anterior lumbar interbody fusion (ALIF) gives better access to the disc space than posterior approaches, permitting more thorough discectomy and larger bone grafts [6,7]. However, ALIF is associated with urological and vascular complications [8]. Posterior procedures include posterior lumbar interbody fusion (PLIF) as well as transforaminal lumbar interbody fusion (TLIF).…”

Section: Introductionmentioning

confidence: 99%

Influence of transforaminal lumbar interbody fusion procedures on spinal and pelvic parameters of sagittal balance

et al. 2011

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Introduction Restitution of sagittal balance is important after lumbar fusion, because it improves fusion rate and may reduce the rate of adjacent segment disease. The purpose of the present study was to describe the impact of transforaminal lumbar interbody fusion (TLIF) procedures on pelvic and spinal parameters and sagittal balance. Materials and methods Forty-five patients who had single-level TLIF were included in this study. Pelvic and spinal radiological parameters of sagittal balance were measured preoperatively, postoperatively and at latest follow-up. Results Age at surgery averaged 58.4 (±9.6) years. Mean follow-up was 35.1 months (±4.1). Twenty-nine percent of the patients exhibited anterior imbalance preoperatively, with high pelvic tilt (17.6°± 7.9°). Of the 32 (71%) patients well balanced before the procedure, 22 (70%) had a large pelvic tilt ([20°), due to retroversion of the pelvis as an adaptive response to the loss of lordosis. Three dural tears (7%) were reported intraoperatively. Interbody cages were more posterior than intended in 27% of the cases. Disc height and lumbar lordosis at fusion level significantly increased postoperatively (p \ 0.05 and p \ 0.001). Pelvic tilt was significantly reduced (p \ 0.01) postoperatively, whereas the global sagittal balance was not significantly modified (p = 0.07). ConclusionSingle-level circumferential fusion helps patients reducing their pelvic compensation, but the amount of correction does not allow for complete correction of sagittal imbalance.

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Section: Introductionmentioning

confidence: 99%

Influence of transforaminal lumbar interbody fusion procedures on spinal and pelvic parameters of sagittal balance

et al. 2011

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“…Although in the early 1970s Stauffer and Coventry condemned this approach because, in their eyes, it meant "too much surgical trauma to the patient" (ref. 5 ), other authors have reported satisfactory results [6][7][8][9][10] . Even a laparoscopic approach for ALIF at the LS level has been described 11,12 , but it seems, this method was associated with considerable technical difficulties as well as with a higher complication rate because of the necessity for preparation and dissection of the major abdominal vessels 10,13 .…”

Section: Discussionmentioning

confidence: 99%

“…Most venous injuries are related to the exposure rather than to implant placement. Mechanisms of injury include excessive venous traction, avulsion, and laceration 9,[14][15][16][17][18] . Peritoneal perforation during retroperitoneal exposure is not uncommon and in these cases immediate closure of these defects when recognized, was performed.…”

Section: Discussionmentioning

confidence: 99%

Surgical complications of the anterior approach to the L5/S1 intervertebral disc

Hrabálek¹,

Adamus²,

Wanek³

et al. 2012

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub

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Aim. The aims of this study were to describe the incidence and type of perioperative complications that occur with minimally invasive anterior retroperitoneal spinal surgery performed at the level of the L5/S1 intervertebral disc. Methods. A retrospective review of 175 patients: 103 women and 72 men, average age 45, who had undergone anterior spinal surgery at level L5/S1 from January 2001 to February 2011. The preoperative diagnoses were: degenerative disc disease in 87 (50%), failed back surgery syndrome in 53 (30%) and spondylolisthesis in 35 patients (20%). The surgical steps in the minimally invasive anterior retroperitoneal approach from the right side to disc L5/S1 are described. All surgical intraoperative anatomical anomalies and complications directly related to the anterior spinal surgery were documented. Results. Intraoperative pathological-anatomical anomalies were found in 34 patients (19%) and intra -and postoperative minor complications in 24 patients (12%) but no serious complications. The main intraoperative complication was peritoneal opening without visceral injury (5%) and the main postoperative complication was weakness of the right abdominal wall (3%). Conclusion. Retroperitoneal access and surgery at level L5/S1 disc space is a safe procedure when performed by a knowledgeable and experienced spine team. During surgical planning for an anterior approach to the LS spine, the surgeon must carefully assess the neuroimaging results, such as MRI, to minimize potentially disastrous vascular complications.

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“…Vascular injuries are however, relatively rare complications ranging from 1.9 to 18% in the literature, with the highest rates being reported in the early 1990s [3][4][5][6][7][8][9][10]. General risk factors for an increased vascular injury risk are: current or previous osteomyelitis or discogenic infection, spondylolisthesis, osteophyte formation which is deemed to be an indicator for inflammatory reaction in the vessel-surrounding area, previous anterior surgery, transitional lumbo-sacral vertebra and cage migration.…”

Section: Case Presentationmentioning

confidence: 99%

The routine intra-operative use of pulse oximetry for monitoring can prevent severe thromboembolic complications in anterior surgery

et al. 2011

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Vascular complications of exposure for anterior lumbar interbody fusion

Abstract: Anterior exposure of the spine for ALIF can be performed safely with a team approach that includes a vascular surgeon. Preoperative evaluation by a vascular surgeon is advisable. Patients with increased BMI and bi-level exposures should be approached with caution.

Cited by 135 publications

References 24 publications

Influence of transforaminal lumbar interbody fusion procedures on spinal and pelvic parameters of sagittal balance

Influence of transforaminal lumbar interbody fusion procedures on spinal and pelvic parameters of sagittal balance

Surgical complications of the anterior approach to the L5/S1 intervertebral disc

The routine intra-operative use of pulse oximetry for monitoring can prevent severe thromboembolic complications in anterior surgery

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