STUDY DESIGN: Modern biomaterials and instrumentation have popularised surgery of the thoraco-lumbar spine through an anterior route. The advantage of anterior surgery is that it allows for a direct decompression of the compromised spinal canal. However, the potential for devastating long-term sequelae as a result of complications is high. PURPOSE: The aim of this study was to give a general overview and identify the incidence of vascular complications. OVERVIEW OF LITERATURE: There is limited literature describing the overall incidence and complications of anterior spinal surgery. METHODS: A retrospective review of a prospective database of 1,262 consecutive patients with anterior surgery over a twelve-year period. RESULTS: In our study, 1.58% (n=20) of patients suffered complications. Injury to a major vessel was encountered in 14 (1.11%) cases, of which nine involved an injury to the common iliac vein. In six cases, the original procedure was abandoned due to a life-threatening vascular injury (n=3) and unfavourable anatomy (n=3). CONCLUSIONS: The incidence of vascular and other complications in our study was relatively low. Nevertheless, the potential for devastating long-term sequelae as a result of complications remains high. A thorough knowledge and awareness of normal and abnormal anatomy should be gained before attempting such a procedure, and a vascular surgical assistance especially should be readily accessible. We believe use of access surgeons is mandatory in cases with difficult or aberrant anatomy.

Department of Spinal Surgery Charles University Medical School Prague Czech Republic

Department of Trauma and Orthopaedics Royal Derby Hospital Derby UK

Department of Trauma and Orthopaedics Royal Derby Hospital Derby UK ; Department of Spinal Surgery Charles University Medical School Prague Czech Republic

Zobrazit více v PubMed

Gumbs AA, Bloom ND, Bitan FD, Hanan SH. Open anterior approaches for lumbar spine procedures. Am J Surg. 2007;194:98–102. PubMed

McDonnell MF, Glassman SD, Dimar JR, 2nd, Puno RM, Johnson JR. Perioperative complications of anterior procedures on the spine. J Bone Joint Surg Am. 1996;78:839–847. PubMed

Brau SA, Delamarter RB, Schiffman ML, Williams LA, Watkins RG. Vascular injury during anterior lumbar surgery. Spine J. 2004;4:409–412. PubMed

Brau SA, Delamarter RB, Schiffman ML, Williams LA, Watkins RG. Left iliac artery thrombosis during anterior lumbar surgery. Ann Vasc Surg. 2004;18:48–51. PubMed

Baker JK, Reardon PR, Reardon MJ, Heggeness MH. Vascular injury in anterior lumbar surgery. Spine (Phila Pa 1976) 1993;18:2227–2230. PubMed

Fantini GA, Pappou IP, Girardi FP, Sandhu HS, Cammisa FP., Jr Major vascular injury during anterior lumbar spinal surgery: incidence, risk factors, and management. Spine (Phila Pa 1976) 2007;32:2751–2758. PubMed

Faciszewski T, Winter RB, Lonstein JE, Denis F, Johnson L. The surgical and medical perioperative complications of anterior spinal fusion surgery in the thoracic and lumbar spine in adults: a review of 1223 procedures. Spine (Phila Pa 1976) 1995;20:1592–1599. PubMed

Westfall SH, Akbarnia BA, Merenda JT, et al. Exposure of the anterior spine. Technique, complications, and results in 85 patients. Am J Surg. 1987;154:700–704. PubMed

Leung YL, Grevitt M, Henderson L, Smith J. Cord monitoring changes and segmental vessel ligation in the "at risk" cord during anterior spinal deformity surgery. Spine (Phila Pa 1976) 2005;30:1870–1874. PubMed

Raskas DS, Delamarter RB. Occlusion of the left iliac artery after retroperitoneal exposure of the spine. Clin Orthop Relat Res. 1997;(388):86–89. PubMed

Kato S, Kawahara N, Tomita K, Murakami H, Demura S, Fujimaki Y. Effects on spinal cord blood flow and neurologic function secondary to interruption of bilateral segmental arteries which supply the artery of Adamkiewicz: an experimental study using a dog model. Spine (Phila Pa 1976) 2008;33:1533–1541. PubMed

Su IC, Chen CM. Spontaneous healing of retroperitoneal chylous leakage following anterior lumbar spinal surgery: a case report and literature review. Eur Spine J. 2007;16:332–337. PubMed PMC