First report of major vascular injury due to lateral transpsoas approach leading to fatality

Assina, Rachid; Majmundar, Neil; Herschman, Yehuda; Heary, Robert F.

doi:10.3171/2014.7.spine131146

Cited by 88 publications

(68 citation statements)

References 21 publications

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“…During the procedure, a tubular retractor system with a detachable, nonfixed anterior blade was used causing injury to the posterior wall of the inferior vena cava and the right iliac vein confluence. The patient was emergently transferred to a university hospital, underwent multiple operations over the course of 4 weeks and died of multiple organ failure due to septic shock [48].…”

Section: Vascular Injurymentioning

confidence: 99%

Lateral Lumbar Interbody Fusion—Outcomes and Complications

Salzmann

Shue

Hughes

2017

Curr Rev Musculoskelet Med

119

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Purpose of Review Lateral lumbar interbody fusion (LLIF) is a relatively new, minimally invasive technique for interbody fusion. The goal of this review is to provide a general overview of LLIF with a special focus on outcomes and complications. Recent Findings Since the first description of the technique in 2006, the indications for LLIF have expanded and the rate of LLIF procedures performed in the USA has increased. LLIF has several theoretical advantages compared to other approaches including the preservation of the anterior and posterior annular/ligamentous structures, insertion of wide cages resting on the dense apophyseal ring bilaterally, and augmentation of disc height with indirect decompression of neural elements. Favorable long-term outcomes and a reduced risk of visceral/vascular injuries, incidental dural tears, and perioperative infections have been reported. However, approach-related complications such as motor and sensory deficits remain a concern. Summary In well-indicated patients, LLIF can be a safe procedure used for a variety of indications.

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Section: Vascular Injurymentioning

confidence: 99%

Lateral Lumbar Interbody Fusion—Outcomes and Complications

Salzmann

Shue

Hughes

2017

Curr Rev Musculoskelet Med

119

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“…4,16 Furthermore, this technique is technically challenging and may not be easily learned or applied. Currently, lateral approaches are used very effectively for coronal realignment, 3 but sagittal realignment has remained challenging.…”

Section: Discussionmentioning

confidence: 99%

Mini-open pedicle subtraction osteotomy as a treatment for severe adult spinal deformities: case series with initial clinical and radiographic outcomes

Wang

Bordon

2016

SPI

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OBJECTIVE Pedicle subtraction osteotomy (PSO) is a powerful but high-risk surgical technique for destabilizing the spine for deformity correction in both the sagittal and coronal planes. Numerous reports have demonstrated the benefits of this technique for realigning the spine in a physiological posture; however, the open surgical technique is associated with a high complication rate. In this report the authors review data obtained in a series of patients who underwent PSO through a less invasive approach. METHODS Sixteen patients with severe coronal- and/or sagittal-plane deformities were treated in this series. Conservative measures had failed in all cases and patients had undergone a single-level PSO or extended PSO at L-2 or L-3. Fixation was accomplished using percutaneous instrumentation and interbody or facet joint fusions were used at the remaining levels. None of the procedures were aborted or converted to a traditional open procedure. Standard clinical and radiographic measures were used to assess patient outcomes. RESULTS Mean age was 68.8 years and mean follow-up duration was 17.7 months. An average of 7.6 levels were fused, and 50% of the patients had bilateral iliac screw fixation, with all constructs crossing both the thoracolumbar and lumbosacral junctions. Operative time averaged 356 ± 50 minutes and there was a mean blood loss of 843 ± 339 ml. The leg visual analog scale score improved from a mean of 5.7 ± 2.7 to one of 1.3 ± 1.6, and the back visual analog scale score improved from a mean of 8.6 ± 1.3 to one of 2.4 ± 2.1. The Oswestry Disability Index score improved from a mean of 50.1 ± 14.4 to 16.4 ± 12.7, representing a mean reduction of 36.0 ± 16.9 points. The SF-36 physical component summary score changed from a mean of 43.4 ± 2.6 to one of 47.0 ± 4.3, and the SF-36 mental component summary score changed from a mean of 46.7 ± 3.6 to 46.30 ± 3.0. Coronal alignment improved from a mean of 27.9 ± 43.6 mm to 16.0 ± 17.2 mm. The lumbar Cobb angle improved from a mean of 41.2° ± 18.4° to 15.4° ± 9.6°, and lumbar lordosis improved from 23.1° ± 15.9° to 48.6° ± 11.7°. Pelvic tilt improved from a mean of 33.7° ± 8.6° to 24.4° ± 6.5°, and the sagittal vertical axis improved from 102.4 ± 73.4 mm to 42.2 ± 39.9 mm. The final lumbar lordosis–pelvic incidence difference averaged 8.4° ± 12.1°. There were 4 patients who failed to achieve less than or equal to a 10° mismatch on this parameter. Ten of the 16 patients underwent delayed postoperative CT, and 8 of these had developed a solid arthrodesis at all levels treated. A total of 6 complications occurred in this series. There were no cases of symptomatic proximal junction kyphosis. CONCLUSIONS Advancements in minimally invasive technique have resulted in the ability to manage increasingly complex deformities with hybrid approaches. In this limited series, the authors describe the results of utilizing a tissue-sparing mini-open PSO to correct severe spinal deformities. This method was technically feasible in all cases with acceptable radiographic outcomes similar to open surgery. However, high complication rates associated with these deformity corrections remain problematic.

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“…Apart from requiring a minimalized approach, it also lowers the risk of injury to abdominal structures. However, eventual vascular injuries that do occur might be very severe due to the difficulty of direct repair based on a very limited access [3][4][5]. This article reports on a case of a direct lesion of a large vein and its repair.…”

Section: Introductionmentioning

confidence: 93%