Technical approach, outcomes, and exposure-related complications in patients undergoing anterior lumbar interbody fusion

Manunga, Jesse; Alcala, Christopher; Smith, Jenna; Mirza, Aleem K.; Titus, Jessica; Skeik, Nedaa; Jayarajan, Senthil N.; Stephenson, Elliot; Alexander, Jason Q.; Sullivan, Timothy M.

doi:10.1016/j.jvs.2020.06.129

Cited by 41 publications

(27 citation statements)

References 20 publications

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“…In a retrospective, single center analysis of their outcomes, Manunga et al. report their technique for anterior lumbar interbody fusion through a midline skin incision and paramedian fascial incision [ 15 ]. Though others may be utilizing an ALIF technique staying midline entirely, to our knowledge, there are no reported data describing this technique [ 13 , 14 ].…”

Section: Discussionmentioning

confidence: 99%

Rapid, midline retroperitoneal exposure for four-level anterior lumbar interbody fusion—technical case atlas

Falahee

Kahn

Heidenreich

et al. 2021

Journal of Surgical Case Reports

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We describe a novel, rapid midline retroperitoneal operative technique in a patient, with multi-level degenerative scoliosis, who underwent an extensive L2-S1 anterior lumbar interbody fusion in addition to posterior instrumentation. Uniquely, our approach enables an essentially midline approach to the rectus muscle and uses the diminution of the transversalis fascia-to-peritoneum transition in the pelvis to provide expedited exposure—making it particularly helpful for ALIF exposure, retraction and intraoperative radiography. We minimize morbidity around the rectus sheath by dissecting only the medial rectus muscle and then gently, bluntly mobilizing the retroperitoneum from the deep pelvis cranially.

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Section: Discussionmentioning

confidence: 99%

Rapid, midline retroperitoneal exposure for four-level anterior lumbar interbody fusion—technical case atlas

Falahee

Kahn

Heidenreich

et al. 2021

Journal of Surgical Case Reports

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“…Risk of vessel injury was found to be higher in retroperitoneal approaches in this review, a difference not reaching significance (p = 0.07). Manunga et al [46] noted their transperitoneal approach allowed them greater scope to mobilise the vessels thus aiding a reduction in damage, and greater operative control, congruent with Lucas et al [42] finding the level of bifurcation required retraction of the iliac vessels far to the right with the retroperitoneal approach, the most common cause of vessel injury.…”

Section: Vascular Injurymentioning

confidence: 75%

“…This was felt likely to be in part due to the use of access surgeons predominantly in multilevel exposure, or difficult anatomical variances. Three studies [2,44,46] evaluated the role of access surgeons in the anterior spinal surgery reported a low vascular complication rate due to the presence of the access surgeon for the entirety of the operation. In contrast, Garg et al [27] reported a 64% vascular injury occurring on approach despite the presence of a vascular surgeon.…”

Section: Use Of Access Surgeonsmentioning

confidence: 99%

Is there a variance in complication types associated with ALIF approaches? A systematic review

Feeley

Clesham

et al. 2021

Acta Neurochir

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Purpose Anterior lumbar interbody fusion (ALIF) is a well-established alternative to posterior-based interbody fusion techniques, with approach variations, such as retroperitoneal, transperitoneal, open, and laparoscopic well described. Variable rates of complications for each approach have been enumerated in the literature. The purpose of this study was to elucidate the comparative rates of complications across approach type. Methods A systematic review of search databases PubMed, Google Scholar, and OVID Medline was made to identify studies related to complication-associated ALIF. PRISMA guidelines were utilised for this review. Meta-analysis was used to compare intraoperative and postoperative complications with ALIF for each approach. Results A total of 4575 studies were identified, with 5728 patients across 31 studies included for review following application of inclusion and exclusion criteria. Meta-analysis demonstrated the transperitoneal approach resulted in higher rates of retrograde ejaculation (RE) (p < 0.001; CI = 0.05–0.21) and overall rates of complications (p = 0.05; CI = 0.00–0.23). Rates of RE were higher at the L5/S1 intervertebral level. Rates of vessel injury were not significantly higher in either approach method (p = 0.89; CI = − 0.04–0.07). Rates of visceral injury did not appear to be related to approach method. Laparoscopic approaches resulted in shorter inpatient stays (p = 0.01). Conclusion Despite the transperitoneal approach being comparatively underpowered, its use appears to result in a significantly higher rate of intraoperative and postoperative complications, although confounders including use of bone morphogenetic protein (BMP) and spinal level should be considered. Laparoscopic approaches resulted in shorter hospital stays; however, its steep learning curve and longer operative time have deterred surgeons from its widespread adaptation.

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“…Complications can be associated with either the ALIF or the posterior instrumentation portions of the procedure. Reported complications are diverse and range from vascular injuries, bowel and ureter injuries, postoperative bleeding requiring reoperation, postoperative paralytic ileus, sacral insufficiency fracture, pseudoarthrosis, and neurological injury [9][10][11][12][13]. A review article on iatrogenic neurologic deficits after lumbar spine surgery reported a 4.1% rate of newonset neurologic injury after anterior or lateral lumbar fusion surgery [10].…”

Section: Discussionmentioning

confidence: 99%

“…The ALIF procedure has been associated with diverse complications such as vascular injuries, injuries to other structures in the peritoneal compartment, fractures, pseudoarthrosis, and neural injury [9][10][11][12][13]. At the L5-S1 level, the ALIF has been associated with L5 radiculopathies [14,15].…”

Section: Introductionmentioning

confidence: 99%

A Technical Nuance to Avoid Lumbar Five Radiculopathy with Anterior Lumbar Fusion and Posterior Instrumentation

Neal

Kalani

Lyons

2021

Case Reports in Orthopedics

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The anterior lumbar interbody fusion (ALIF) is a well-established procedure used to treat a multitude of spinal pathologies. When performed at the L5-S1 level, the ALIF is often supplemented with posterior pedicle screw and rod fixation. Because the interbody device can restore disk and foraminal height, one benefit of the ALIF procedure is indirect neural decompression in the spinal canal and neural foramina. If the contour of the posterior rod is not matched to the exact position of the tulip heads on the pedicle screws, spondylolisthesis can be introduced, leading to foraminal stenosis and nerve compression. This concern is particularly germane when the posterior instrumentation is placed percutaneously without any direct foraminal decompression. In this report, we describe a patient who had an L4-S1 ALIF, resulting in new L5-S1 retrolisthesis and worsening L5 radiculopathy. Technical nuances and avoidance strategies are discussed.

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Technical approach, outcomes, and exposure-related complications in patients undergoing anterior lumbar interbody fusion

Cited by 41 publications

References 20 publications

Rapid, midline retroperitoneal exposure for four-level anterior lumbar interbody fusion—technical case atlas

Rapid, midline retroperitoneal exposure for four-level anterior lumbar interbody fusion—technical case atlas

Is there a variance in complication types associated with ALIF approaches? A systematic review

A Technical Nuance to Avoid Lumbar Five Radiculopathy with Anterior Lumbar Fusion and Posterior Instrumentation

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