Management of Vascular Complications during Anterior Lumbar Spinal Surgery Using Mini-Open Retroperitoneal Approach

Pelletier, Yann; Lareyre, Fabien; Cointat, Caroline; Raffort, Juliette

doi:10.1016/j.avsg.2021.01.077

Cited by 12 publications

(8 citation statements)

References 39 publications

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“…This is where MRV and IVC are the gold standards for the detection of pelvic vein thrombosis, in cases of iliac vein repair after anterior spine surgery. In the case of a proximal vein thrombosis, an IVC filter is then placed [ 15 - 16 ].…”

Section: Reviewmentioning

confidence: 99%

Vascular Injury in Elective Anterior Surgery of the Lumbar Spine: A Narrative Review

Pappa¹,

Evangelopoulos²,

Benetos³

et al. 2021

Cureus

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The incidence of anterior lumbar surgery is increasing as the population is aging. Although adverse events regarding vasculature injury are uncommon, several have been described in the current literature. Complications can be categorized based on the time of occurrence, more specifically intraoperative or postoperative, but also regarding the nature of vascular damage such as thrombosis, occlusion, or rupture. The rate of complications is higher in the setting of revision anterior surgery than with primary anterior lumbar surgery. Moreover, the incidence of revision anterior surgery is also increasing in contrast to the past. Through this narrative review, an effort is made for a thorough understanding of the complications associated with anterior lumbar surgery, which will aid in the prevention, recognition, and management of this rare complication.

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Section: Reviewmentioning

confidence: 99%

Vascular Injury in Elective Anterior Surgery of the Lumbar Spine: A Narrative Review

Pappa¹,

Evangelopoulos²,

Benetos³

et al. 2021

Cureus

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Section: Introductionmentioning

confidence: 99%

“…The anterior surgical approach to the lumbosacral spine is preferred during pelvic and spinal surgeries [1][2][3]. Vascular injuries during anterior exposure are potentially lifethreatening [3]. The mechanisms of injury to vascular structures include excessive traction, avulsion, and/or laceration [2].…”

Section: Introductionmentioning

confidence: 99%

Topography and Composition of the Iliolumbar Veins in a South African Cohort: Implications for Spinal Surgery

2023

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A descriptive cross-sectional study of the anatomical variations, morphometry, and histology of the iliolumbar veins (ILVs).Purpose: This study aimed to describe the anatomical variations of the ILVs and determine their tissue composition in South African cadavers of European descent. Overview of Literature: A safe anterior surgical approach to the L4/L5 intervertebral disc space requires understanding the anatomy of the ILVs. Limited understanding of ILVs and their variations may lead to inadvertent avulsion of veins with subsequent hemorrhage and damage to the adjacent nerves intraoperatively. Variations in ILVs are population specific, but such reports are limited in the South African population. Methods: Eighty-nine adult cadavers were dissected to reveal ILV patterns. The variations (origin, course, and drainage pattern), morphometries, and topography of the ILVs were studied. A total of 19 (10 proximal, nine distal) ILVs were processed for hematoxylin and eosin, Masson's trichrome, and Verhoeff's histological staining to determine the tissue composition. Results: The ILVs were identified in 100% of the cases, and 45% of the ILVs were anastomosed to each other bilaterally. The rightside ILVs terminated into the posterior surfaces of the iliac vessels (p=0.001), whereas the left-side ILVs terminated into the lateral surfaces (p=0.001). The left-side proximal ILVs had higher elastic fiber composition (p=0.030). The ratio of the ILVs' elastic fibers to collagen fibers was 1:9, and 61% of the cadavers exhibited type 1 ILV pattern. Moreover, 42% of the ILVs were at the S1 vertebral level with 31% lying between L4 and L5 spinal nerve roots. The obturator nerve coursed anteriorly to the ILVs in 96% of cases. Conclusions: The ILV variations described for South Africans present new additional patterns, such as bilateral anastomosis and laterality of the terminal drainage. The ILVs have more collagen fibers than elastic fibers, predisposing them to avulsion during surgical retraction. The identification of all the ILVs is crucial to minimize inadvertent hemorrhage and damage to adjacent structures.

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“…Given the unique risk profile associated with the anterior approach, a number of previous studies have highlighted the importance of comprehensively understanding and mapping vascular anatomy during preoperative planning. [6][7][8] In their imaging analysis using computed tomography angiography, Barrey and colleagues reported a significant degree of variability in the vascular anatomy immediately adjacent to the lumbar spine from one patient to the next. Lower abdominal vasculature is especially relevant for preoperative planning of ALIF procedures as this anatomy will often dictate the size and borders of the "window" through which surgeons can approach the disk space.…”

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confidence: 99%

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confidence: 99%

Risk Assessment of Anterior Lumbar Interbody Fusion Access in Degenerative Spinal Conditions

Singh¹,

Elliot²,

Lynch³

et al. 2022

Clinical Spine Surgery: A Spine Publication

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Study Design: This was a retrospective cohort study. Objective: Develop an evidence-based preoperative risk assessment scoring system for patients undergoing anterior lumbar interbody fusion (ALIF). Summary of Background Data: ALIF may hold advantages over other fusion techniques in sagittal restoration and fusion rates, though it introduces unique risks to vascular and abdominal structures and thus possibly increased risk of operative morbidity. Methods: Primary, 1 or 2-level ALIFs were identified in a surgical registry. Baseline characteristics were recorded. Axial magnetic resonance imagings at L4–L5 and L5–S1 were reviewed for vascular confluence/bifurcation or anomalous structures, and measured for operative window size/slope. To assess favorable outcomes, a clinical grade was calculated: (clinical grade=blood loss×operative duration), higher value indicating poorer outcome. To establish a risk scoring system, a base risk score algorithm was established and stratified into 5 categories: high, high to intermediate, intermediate, intermediate to low, and low. Modifiers to base risk score included age, body mass index, operative level, history of bone morphogenic protein use, calcified vasculature, spondylolisthesis grade, working window size and slope, and abnormal vasculature. Modifiers were weighted for contribution to surgical risk. A total risk score was calculated and evaluated for strength of association with clinical outcome grades by Pearson correlation coefficient. Results: A total of 65 patients were included. Mean clinical outcome grade was 5.6, mean total risk score 21.3±21.5. Multilevel procedures (L4–S1) mean total risk score was 57.3±7.8. L4–L5 mean total risk score was 23.6±5.2; L5–S1 mean total risk score 8.3±6.6. Correlation analysis demonstrated a significant and strong relationship (|r|=0.753; P<0.001) between total risk scores and clinical outcome grades. Conclusion: Calculated ALIF risk scores significantly correlated with operative duration and blood loss. This scoring system represents a potential framework to facilitate clinical decision-making and risk assessment for potential ALIF candidates with degenerative spinal pathologies.

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Management of Vascular Complications during Anterior Lumbar Spinal Surgery Using Mini-Open Retroperitoneal Approach

Cited by 12 publications

References 39 publications

Vascular Injury in Elective Anterior Surgery of the Lumbar Spine: A Narrative Review

Vascular Injury in Elective Anterior Surgery of the Lumbar Spine: A Narrative Review

Topography and Composition of the Iliolumbar Veins in a South African Cohort: Implications for Spinal Surgery

Risk Assessment of Anterior Lumbar Interbody Fusion Access in Degenerative Spinal Conditions

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