Revision open anterior approaches for spine procedures

Gumbs, Andrew A.; Hanan, Scott H.; Yue, James J.; Shah, Rahul V.; Sumpio, Bauer E.

doi:10.1016/j.spinee.2006.05.015

Cited by 46 publications

(17 citation statements)

References 20 publications

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“…During anterior exposure, the ureter must be carefully identified to prevent iatrogenic injury. Authors agree that ureteral stenting should be performed to make the ureter a palpable retroperitoneal structure and enhance diagnosis of ureteral tear intraoperatively [2,5,16,17]. In Fig.…”

Section: Discussionmentioning

confidence: 95%

“…The formation of adhesions after the primary surgery increases the potential for iatrogenic injury during the revision exposure [12]. If complications related to anterior exposure of the lumbar spine in primary surgeries have been well reported in the literature [1,5,19], only a few studies have reported the technical difficulties and the complications associated with revision surgeries through an anterior approach [2,9,11,[13][14][15][16][17].…”

Section: Discussionmentioning

confidence: 99%

“…In an attempt to avoid vascular injury and limit SD standard deviation blood loss during spine exposure, it is essential to obtain control of the vessels proximally and/or distally at previously nonoperated levels before mobilization of the vasculature and exposure of the target intervertebral level [13]. Vascular studies should be performed preoperatively to assess the position of the vessels [2,12,16]. We usually order a preoperative CT without injection, but with 3D reconstruction of the major vessels and lumbar spine to anticipate difficulties in the exposure (Fig.…”

Section: Discussionmentioning

confidence: 99%

“…Anterior approach to the lumbar spine has become an increasingly popular procedure due to the increased use of anterior lumbar interbody fusion (ALIF) and artificial total disc replacement (TDR) [1,2]. The complications associated with the anterior approach to the lower lumbar spine are summarized in Table 1.…”

Section: Introductionmentioning

confidence: 99%

“…The formation of adhesions of veins, arteries, ureter, nerve plexus, and peritoneum to the spine increases the potential for iatrogenic injury during the revision exposure [12]. The literature review found little data about complications related to revision anterior lumbar spine surgery [2,9,11,[13][14][15][16][17][18].…”

Section: Introductionmentioning

confidence: 99%

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Analysis of intraoperative difficulties and management of operative complications in revision anterior exposure of the lumbar spine: a report of 25 consecutive cases

et al. 2012

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Purpose After a first anterior approach to the lumbar spine, formation of adhesions of soft tissues to the spine increases the surgical difficulties and potential for iatrogenic injury during the revision exposure. The objective of this study was to identify the intraoperative difficulties and postoperative complications associated with revision anterior lumbar spine procedures in a single institution. Methods This is a retrospective review of 25 consecutive anterior revision lumbar surgeries in 22 patients (7 men and 15 women) operated on between 1998 and 2011. Patients with trauma or malignancies were excluded. The mean age of the patients at the time of revision surgery was 56 years (range 20-80 years). The complications were analyzed depending on the operative level and the time between the index surgery and the revision. Results Six major complications (five intraoperatively and one postoperatively) occurred in five patients (20 %): three vein lacerations (12 %) and two ureteral injuries (8 %), despite the presence of a double-J ureteral stent. The three vein damages were repaired or ligated by a vascular surgeon. One of the two ureteral injuries led to a secondary nephrectomy after end-to-end anastomosis failure; the other necessitated secondary laparotomy for small bowel obstruction. Conclusions Anterior revision of the lumbar spine is technically challenging and is associated with a high rate of vascular or urologic complications. Therefore, the potential complications of the procedure must be weighted against its benefits. When iterative anterior lumbar approach is mandatory, exposure should be performed by an access surgeon in specialized centers that have ready access to vascular and urologic surgeons.

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Section: Discussionmentioning

confidence: 95%