Approach-Related Complications of Anterior Lumbar Interbody Fusion: Results of a Combined Spine and Vascular Surgical Team

Abstract

Study Design Retrospective analysis of prospectively collected cohort data. Objective Anterior lumbar interbody fusion (ALIF) is a commonly performed procedure for the treatment of degenerative diseases of the lumbar spine. Detailed and comprehensive descriptions of intra- and postoperative complications of ALIF are surprisingly limited in the literature. In this report, we describe our experience with a team model for ALIF and report all complications occurring in our patient series. Methods Patients were prospectively enrolled between January 2009 and January 2013 by a combined spine surgeon and vascular surgeon team. All patients underwent an open ALIF using an anterior approach to the lumbosacral spine. Results From the 227 ALIF cases, mean operative blood loss was 103 mL, ranging from 30 to 900 mL. Mean operative time was 78 minutes. The average length of stay was 5.2 days. Intraoperative vascular injury requiring primary repair with suturing occurred in 15 patients (6.6%). There were 2 cases of postoperative retroperitoneal hematoma. Three patients (1.3%) had incisional hernia requiring revision surgery; 7 (3.1%) patients had prolonged ileus (>7 days) managed conservatively. Four patients described retrograde ejaculation. Sympathetic dysfunction occurred in 15 (6.6%) patients. There were 5 (2.2%) cases of superficial wound infection treated with oral antibiotics, with no deep wound infections requiring reoperation or intravenous therapy. There were no mortalities in this series. Conclusions ALIF is a safe procedure when performed by a combined vascular surgeon and spine surgeon team with acceptably low complication rates. Our series confirms that the team approach results in short operative times and length of stay, with rapid control of intraoperative vessel injury and low overall blood loss.

L5/S1 anterior lumbar interbody fusion technique

“…However, with the anterior approach there is the need to access through the abdomen via a retroperitoneal approach, with the potential risk for vascular and visceral injuries; and retrograde ejaculation (2,3,7,8). The vascular injury is a major concern, however when the ALIF procedure is performed by a team of a vascular surgeon and spine surgeon-there is a reduction in vascular injuries, operation time and duration of hospital stay (9,10). Furthermore, there is a lower complication rate with regards to harvest of autograft, and a higher fusion rate when bone graft substitutes such as allograft and bone morphogenetic protein is added to the implant device for the ALIF procedure (11).…”

Sexual and urinary function following anterior lumbar surgery in females

“…Injuries of the ureter, bladder or the intraperitoneal content are less common. However, as the superior and inferior hypogastric plexus with the sympathetic and parasympathetic fibres unsheathes the large abdominal vessels and run in close proximity with the anterior longitudinal ligament, sympathetic and parasympathetic nerves may be affected during anterior procedures …”

“…However, as the superior and inferior hypogastric plexus with the sympathetic and parasympathetic fibres unsheathes the large abdominal vessels and run in close proximity with the anterior longitudinal ligament, sympathetic and parasympathetic nerves may be affected during anterior procedures. 3 The autonomic nervous system plays an important role in urogenital function: [4][5][6] Sympathetic fibers are responsible for inhibition of the detrusor and contraction of the bladder neck (internal sphincter), resulting in storage of urine. Parasympathetic efferents lead to detrusor contraction and promote voiding, which is finally achieved by voluntary relaxation of the external urethral sphincter innervated by the somatic pudendal nerve.…”

Intraoperative navigation for accurate midline placement of anterior lumbar interbody fusion and total disc replacement prosthesis

“…Anterior lumbar approach techniques for the management of discogenic back pain and placement of spinal instrumentation such as fusion and disc replacement prosthesis is becoming increasingly popular (1)(2)(3)(4)(5)(6)(7). However, these procedures may provide the surgeon with a limited view of the anatomy around the target region of the spine, with potential poor placement of spinal prosthesis (8).…”