Vascular injury during anterior lumbar surgery*1

Brau, Salvador A.; Delamarter, Rick B.; Schiffman, Michael; Williams, Lytton; Watkins, Robert G.

doi:10.1016/j.spinee.2003.12.003

Cited by 250 publications

(84 citation statements)

References 9 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…However, it is well recognized that the anterior approach may result in severe, sometimes life threatening intraoperative complications, because the surgeon has to work in proximity of major anatomical structures [4,6,19,21]. Nevertheless, with the help of vascular or general surgeons that are familiar with these approaches, the incidence of major complications can remain very low [1,27].…”

Section: Discussionmentioning

confidence: 99%

Clinical and radiological outcome of anterior–posterior fusion versus transforaminal lumbar interbody fusion for symptomatic disc degeneration: a retrospective comparative study of 133 patients

Faúndez¹,

Schwender

Safriel³

et al. 2009

Eur Spine J

View full text Add to dashboard Cite

Abundant data are available for direct anterior/ posterior spine fusion (APF) and some for transforaminal lumbar interbody fusion (TLIF), but only few studies from one institution compares the two techniques. One-hundred and thirty-three patients were retrospectively analyzed, 68 having APF and 65 having TLIF. All patients had symptomatic disc degeneration of the lumbar spine. Only those with one or two-level surgeries were included. Clinical chart and radiologic reviews were done, fusion solidity assessed, and functional outcomes determined by pre-and postoperative SF-36 and postoperative Oswestry Disability Index (ODI), and a satisfaction questionnaire. The minimum follow-up was 24 months. The mean operating room time and hospital length of stay were less in the TLIF group. The blood loss was slightly less in the TLIF group (409 vs. 480 cc.). Intra-operative complications were higher in the APF group, mostly due to vein lacerations in the anterior retroperitoneal approach. Postoperative complications were higher in the TLIF group due to graft material extruding against the nerve root or wound drainage. The pseudarthrosis rate was statistically equal (APF 17.6% and TLIF 23.1%) and was higher than most published reports. Significant improvements were noted in both groups for the SF-36 questionnaires. The mean ODI scores at follow-up were 33.5 for the APF and 39.5 for the TLIF group. The patient satisfaction rate was equal for the two groups.

show abstract

Section: Discussionmentioning

confidence: 99%

Clinical and radiological outcome of anterior–posterior fusion versus transforaminal lumbar interbody fusion for symptomatic disc degeneration: a retrospective comparative study of 133 patients

Faúndez¹,

Schwender

Safriel³

et al. 2009

Eur Spine J

View full text Add to dashboard Cite

show abstract

“…Previous studies have shown that vascular complications occurred in 0.4-15 % of primary ALIF procedures [3,5,[20][21][22][23], whereas they occurred in 10-57 % in revision surgeries [13,14,16]. As in the three cases in our series, vascular injuries can occur during the surgical approach to the spine [13], but they can also happen while the discectomy (or implant removal) is being performed [5].…”

Section: Discussionmentioning

confidence: 50%

“…As in the three cases in our series, vascular injuries can occur during the surgical approach to the spine [13], but they can also happen while the discectomy (or implant removal) is being performed [5]. They are more frequent at L4-L5 than at L5-S1, because of the position of the iliac bifurcation and tethering of the iliolumbar vein [3,5,13]. 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].…”

Section: Discussionmentioning

confidence: 76%

“…3). 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).…”

Section: Discussionmentioning

confidence: 99%

“…The complications associated with the anterior approach to the lower lumbar spine are summarized in Table 1. The incidence of vascular injury is estimated at 1.9-8 %, with the greatest risk at the L4-L5 level [3][4][5]. Ureteral injury during anterior lumbar arthrodesis has been reported in only a small number of cases [3,[5][6][7][8][9][10][11].…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

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

View full text Add to dashboard Cite

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.

show abstract

The Open Anterior Paramedian Retroperitoneal Approach for Spine Procedures

Gumbs

Shah²,

Yue³

et al. 2005

Arch Surg

View full text Add to dashboard Cite

Hypothesis: With the advent of anterior lumbar interbody fusion and artificial disk replacement as common procedures for the treatment of many spinal problems, anterior exposure has become an increasingly popular procedure for general, thoracic, urologic, and vascular surgeons. Despite this, the body of literature describing this procedure, especially the general and vascular surgery literature, is lacking. Design: A retrospective review of medical records was performed for patients operated on from April 2002 to March 2004. Setting: Tertiary care university hospital. Patients: In total, 64 open retroperitoneal exposures for anterior spinal approaches were performed. Thirty-five (55%) were performed on men and 29 (45%) on women. Interventions: Fifty patients (78%) required lumbosacral approaches, and 14 (22%) required access to purely lumbar disk spaces. Forty-three patients underwent singledisk approaches, and 21 required access to either 2 or 3 levels. Forty patients (63%) underwent anterior lumbar interbody fusion, and 22 (34%) had a Prodisc disk replacement. Main Outcome Measures: We analyzed intraoperative and early postoperative complications. Results: The average age was 43 years (range, 25-89 years), 42 and 44 years for men and women, respectively. Ninetyseven percent of all attempted retroperitoneal exposures were successful. Intraoperative complications occurred in 5 patients (8%) and included inability to mobilize the iliac veins, injury to the iliac vein, and ureteral tear. The postoperative course was complicated in 8 patients (14%) and included fever, urinary retention, spinal headache, Clostridium difficile colitis, and ileus. Conclusion: Open retroperitoneal exposure to the lumbar and lumbosacral vertebral bodies can be performed safely with a multidisciplinary approach that maximizes the various surgical skills of the orthopedic and vascular or general surgeon, reducing complication rates in anterior spinal surgery.

show abstract

Vascular injury during anterior lumbar surgery*1

Cited by 250 publications

References 9 publications

Clinical and radiological outcome of anterior–posterior fusion versus transforaminal lumbar interbody fusion for symptomatic disc degeneration: a retrospective comparative study of 133 patients

Clinical and radiological outcome of anterior–posterior fusion versus transforaminal lumbar interbody fusion for symptomatic disc degeneration: a retrospective comparative study of 133 patients

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

The Open Anterior Paramedian Retroperitoneal Approach for Spine Procedures

Contact Info

Product

Resources

About