Anterior Lumbar Interbody Fusion in Left‐sided Inferior Vena Cava and Right‐sided Aortic Arch

Abstract

Spinal fusion via anterior lumbar interbody fusion (ALIF) can offer symptomatic relief to patients that suffer severe low back pain, radiculopathy, and claudication. However, a detailed working knowledge of the thoracic, abdominal, and lumbar anatomy, particularly of the vasculature, is vital. We report the case of a 68-year-old man who presented with radiculopathy and progressively worsening low back pain despite 9 months of unsuccessful conservative therapy and pain management. Preoperative computed tomography and magnetic resonance imaging revealed a rare anatomical variation, with an anomalous left-sided inferior vena cava and anomalous aorta. The patient was surgically treated with ALIF at L 4,5 and L 5 S 1 via an altered surgical window. Given the anomalous anatomy of the patient, instead of performing the procedure after mobilizing both of the transposed abdominal great vessels, the inferior vena cava and the abdominal aorta, the ALIF was uneventfully performed in the window between these vessels. There were no perioperative or postoperative complications. At 12-week postoperative follow-up, X-ray imaging demonstrated successful implantation of ALIF cages with no recurrence of symptoms. A detailed working knowledge of anatomy is important, particularly if anatomical variations are present. This has implications for preoperative surgical planning, which is integral to the safety and the success of procedures.

Venous Anomalies Complicating Anterior Lumbar Interbody Fusion Exposures

“…To our knowledge, there have only been a few case reports on vascular anomalies affecting an ALIF. [18][19][20][21] There is limited literature on other vascular anomalies in the context of OLIF. One study described the incidence of internal iliac vein (IIV) and common iliac vein (CIV) variations; high joining of the IIV to the ipsilateral CIV-8.7%: IIV joining contralateral CIV, 2.3%: double IVC-.9%.…”

Oblique Lumbar Interbody Fusion from the Right-Side Approach in the Treatment of a Patient with Left-Sided Inferior Vena Cava

“…Currently, there is consensus among the spine surgeons that detailed preoperative evaluation of the prevertebral anatomy is of vital importance in the anterior or anterior oblique lumbar surgery, especially the variation in vascular anatomy [2,9,11,12,21]. The presence of a left-sided IVC can be initially identified on preoperative CT or MRI cross-sectional images of the lumbar spine.…”

Is there a variance in complication types associated with ALIF approaches? A systematic review

“…Efforts to mitigate against complications associated with the procedure have led to the development of variations on the surgical approach [63]. In particular, risk of to the great vessels is inherent in their mobilisation [57], whilst also at risk are the peritoneal visceral contents [30] and the ureter [30]. Damage to the hypogastric plexus may result in retrograde ejaculation in men [20].…”