Anterior lumbar spine surgery: a systematic review and meta-analysis of associated complications

Applying the Mini-Open Anterolateral Lumbar Interbody Fusion with Self-Anchored Stand-Alone Polyetheretherketone Cage in Lumbar Revision Surgery

“…Anterior lumbar spinal surgery has been commonly used in conditions that include disc degeneration, trauma, infection, deformity, and tumor with approaches such as ALIF, XLIF, and OLIF [7]. Recently, these anterior approaches were adopted in lumbar revision surgery [5, 22].…”

“…Moreover, the cage was easily inserted obliquely along this access angle, which largely reduced the manipulation of the aorta and vena cava, decreasing the risk of vascular injury compared with ALIF. Retraction of vascular structures throughout an entire procedure was blamed for the increase in vessel injuries and thrombotic events in OLIF [7, 29]. Therefore, we used hand-held abdominal retractors instead of self-retaining retractors to expose the discs, for they could be released intermittently to minimize the risk of vascular thrombosis.…”

“…It provides direct access to the vertebral column and allows more extensive decompression of the disc space and better end plate preparation for arthrodesis, while simultaneously restoring disc height and correct lumbar kyphosis [6]. Moreover, ALIF avoids posterior muscle trauma, adjacent-level facet joint violation, and acceleration of ASD [6, 7]. Nevertheless, access-related complications have been documented, such as urethral injury, bowel perforation, incisional hernia, neurological injury, ileus, and retrograde ejaculation in men, with vascular injury being the most disastrous [2, 7–11].…”

“…Moreover, ALIF avoids posterior muscle trauma, adjacent-level facet joint violation, and acceleration of ASD [6, 7]. Nevertheless, access-related complications have been documented, such as urethral injury, bowel perforation, incisional hernia, neurological injury, ileus, and retrograde ejaculation in men, with vascular injury being the most disastrous [2, 7–11]. The transpsoas exposure of extreme lateral interbody fusion (XLIF) reduces manipulation of the aorta and vena cava; hence, the incidence of vascular injury is lower [12–15].…”

Operative Management of Lumbar Degenerative Disc Disease

“…These disadvantages have led to a movement of surgeons employing the expertise of "access" vascular surgeons and intraoperative heparin administration to facilitate access to the intervertebral disc in the hope of reducing complications for the patient [686970]. Bateman et al [71] undertook a systematic review of the complication of anterior approach surgery finding intraoperative and postoperative complication rates of 9.1% and 5.2%, respectively. The most common complications reported were venous injury (3.2%), retrograde ejaculation (2.7%), neurologic injury (2%), prosthesis related (2%), postoperative ileus (1.4%), superficial infection (1%), and others (1.3%).…”