The role of the vascular surgeon in anterior retroperitoneal spine exposure: Preservation of open surgical training

Chiriano, Jason; Abou-Zamzam, Ahmed M.; Urayeneza, Olivier; Zhang, Wayne W.; Cheng, Wayne K.

doi:10.1016/j.jvs.2009.01.007

Cited by 113 publications

(92 citation statements)

References 8 publications

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“…They found 11 % incidence of major and 24 % incidence of minor complications. Chiriano et al [32] found the incidence of minor Numerals refer to number of patients vascular injuries (requiring repair) to be 24 %, while the incidence of serious vascular injury was 3 %. Jarrett et al [33] reported that even the use of an expert ''access surgeon'' for anterior trans-lumbar approach did not reduce the incidence of complications.…”

Section: Discussionmentioning

confidence: 99%

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Isolated posterior instrumentation for selected cases of thoraco-lumbar spinal tuberculosis without anterior instrumentation and without anterior or posterior bone grafting

Kumar¹,

Joseph²,

Manur³

2012

Eur Spine J

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Purpose The aim of this prospective study is the analysis of the clinical and radiological outcomes of active thoracolumbar spinal tuberculosis treated with isolated posterior instrumentation without any posterior bone grafting or anterior inter-body bone grafting or anterior instrumentation. Methods The study was a prospective follow-up of 25 patients with active thoraco-lumbar spinal tuberculosis who underwent posterior spinal instrumentation with pedicle screws and rods. These patients had posterior stabilization of the involved segment of the spine without anterior or posterior bone grafting. The mean duration of follow-up was 3.3 years and the minimum duration of follow-up was 2 years. Results The mean kyphotic angle improved from 32.4°p re-operatively to 7.2°in the early follow-up period. Following a minor loss of correction during follow-up, the mean kyphotic angle settled at 11.5°at the time of final follow-up. Inter-body bony fusion was noticed at the final follow-up in all patients despite the absence of anterior bone grafting or cages. Conclusion Posterior instrumented stabilization followed by chemotherapy seems to be adequate for obtaining satisfactory healing of the lesions. Anterior inter-body bony arthrodesis occurs despite the absence of anterior bone grafts or cages. Careful patient selection is critical for successful outcome with this technique.

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Section: Discussionmentioning

confidence: 99%

“…In the presence of diseased anterior column, laminectomy is said to aggravate the spinal instability [32,33]. Stability of the vertebral column following posterior decompression is no longer a major concern following the advent of contemporary posterior segmental spinal instrumentation systems.…”

Section: Discussionmentioning

confidence: 99%

Isolated posterior instrumentation for selected cases of thoraco-lumbar spinal tuberculosis without anterior instrumentation and without anterior or posterior bone grafting

Kumar¹,

Joseph²,

Manur³

2012

Eur Spine J

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“…3,7,10,11 Because of advances in surgical techniques and surgeon comfort, thoracolumbar corpectomies are increasingly performed via a posterior approach. 1,8,9,12,13,16 In our study, we found similar morbidity for the anterior-only and transpedicular approaches with regard to complication rate, EBL, and operative time.…”

Section: Discussionmentioning

confidence: 99%

The transpedicular approach compared with the anterior approach: an analysis of 80 thoracolumbar corpectomies

Lau²,

Lee³

et al. 2010

SPI

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A nterior spinal pathological entities of the thoracolumbar spine have traditionally been treated by an anterior transthoracic, thoracolumbar, or retroperitoneal approach. Also used has been a posterior surgery via costotransversectomy or extracavitary approaches. The transpedicular corpectomy is a variant of the costotransversectomy and extracavitary approaches in that the rib head is preserved as the corpectomy is being performed, and the corpectomy is performed through the pedicles. Various techniques have been described to deal with the rib head to perform anterior spinal reconstruction. [4][5][6] With advances in surgical techniques, many operations that traditionally have been performed through anterior spinal approaches (including multilevel corpectomies) are now being performed via posterior approaches. We wished to evaluate whether one approach was superior to the other with regard to complications, neurological outcome, morbidity, and other perioperative factors. Object. Whereas standard anterior approaches for thoracolumbar corpectomies have commonly been used, the transpedicular technique is increasingly used to perform corpectomies from a posterior approach. The authors conducted a study to analyze whether there was a difference in outcomes by comparing transpedicular corpectomies to standard anterior thoracolumbar corpectomies. MethodsMethods. The senior author performed thoracolumbar corpectomies in 80 patients between 2004 and 2008. The authors reviewed medical records and follow-up data, consisting of clinic visits, radiographs, or telephone interviews. Neurological outcome, complications, operative times, revision surgery rates, and estimated blood loss (EBL) were evaluated.Results. Thirty-four patients underwent transpedicular corpectomies, and 46 patients underwent anterior thoracolumbar approaches. Single-level transpedicular corpectomies appear to be comparable to anterior-only corpectomies in terms of EBL, operative time, and complication rates. There was a higher complication rate, increased EBL, and longer operative time with anterior-posterior corpectomies compared with transpedicular corpectomies. Patients undergoing transpedicular corpectomies had a greater recovery of neurological function than those in whom anteriorapproach corpectomies were performed.Conclusions. The transpedicular corpectomy appears to have a comparable morbidity rate to anterior-only corpectomies, but its morbidity rate is lower than that of anterior-posterior corpectomies.

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“…Brau et al [3] also use CT to assess the inflammation around the vessels and predict difficult dissection. Experienced access surgeons should be consulted [13,24], especially if local conditions are not satisfactory (major adhesions, sepsis, L4-L5 or L5-S1 level, surgery at the same spinal level, necessity of implant removal). In our series, an orthopedic surgeon performed all the approaches, but a vascular surgeon had to perform the three vascular repairs.…”

Section: Discussionmentioning

confidence: 99%

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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The role of the vascular surgeon in anterior retroperitoneal spine exposure: Preservation of open surgical training

Cited by 113 publications

References 8 publications

Isolated posterior instrumentation for selected cases of thoraco-lumbar spinal tuberculosis without anterior instrumentation and without anterior or posterior bone grafting

Isolated posterior instrumentation for selected cases of thoraco-lumbar spinal tuberculosis without anterior instrumentation and without anterior or posterior bone grafting

The transpedicular approach compared with the anterior approach: an analysis of 80 thoracolumbar corpectomies

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

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