Anterior Exposure of the Spine for Removal of Lumbar Interbody Devices and Implants

Abstract

Anterior removal of lumbar interbody devices placed anteriorly or posteriorly has a high incidence of complication. Average blood loss and hospital stay are increased with revision anterior surgery. The vascular complication rate is 2-fold higher at L4-L5 level compared to L5-S1.

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

“…As in the three cases in our series, vascular injuries can occur during the surgical approach to the spine [13], but they can also happen while the discectomy (or implant removal) is being performed [5]. They are more frequent at L4-L5 than at L5-S1, because of the position of the iliac bifurcation and tethering of the iliolumbar vein [3,5,13]. In an attempt to avoid vascular injury and limit SD standard deviation blood loss during spine exposure, it is essential to obtain control of the vessels proximally and/or distally at previously nonoperated levels before mobilization of the vasculature and exposure of the target intervertebral level [13].…”

“…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].…”

“…Previous studies have shown that vascular complications occurred in 0.4-15 % of primary ALIF procedures [3,5,[20][21][22][23], whereas they occurred in 10-57 % in revision surgeries [13,14,16]. As in the three cases in our series, vascular injuries can occur during the surgical approach to the spine [13], but they can also happen while the discectomy (or implant removal) is being performed [5]. They are more frequent at L4-L5 than at L5-S1, because of the position of the iliac bifurcation and tethering of the iliolumbar vein [3,5,13].…”

“…Revision surgery might be necessary in case of TDR failure, ALIF pseudarthrosis, infection or interbody device malposition or migration [12,13]. The formation of adhesions of veins, arteries, ureter, nerve plexus, and peritoneum to the spine increases the potential for iatrogenic injury during the revision exposure [12].…”

“…The formation of adhesions of veins, arteries, ureter, nerve plexus, and peritoneum to the spine increases the potential for iatrogenic injury during the revision exposure [12]. The literature review found little data about complications related to revision anterior lumbar spine surgery [2,9,11,[13][14][15][16][17][18].…”