Complications of the Anterior Approach to Lumbar Spine in a Series of 197 Patients
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Published:
Dec 20, 2023
Keywords:
Anterior lumbar approach, surgical complications, anterior arthrodesis, instrumented anterior arthrodesis, vascular injury
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Abstract
Objective: To analyze complications related to the anterior approach to the lumbar spine.
Materials and Methods: Descriptive and retrospective study of a series of patients who underwent surgery by an anterior approach to the lumbar spine between 2006 and 2019. The study population was 197 patients. The variables considered were age, gender, diagnosis, surgical plan, lumbar levels involved, and the presence of immediate, early or late complications. The Clavien-Dindo classification was used for surgical complications.
Results: 197 patients were evaluated. The average age was 53.39 years, and there were 106 women (53.81%) and 91 men (46.19%). The most frequent diagnosis was degenerative disc disease in 51 patients (25.89%). 34 patients presented complications (17.26%): 4 immediate complications (2.03%), 22 early complications (11.16%), and 9 late complications (4.57%). The most frequent immediate complication was arterial injury (2 patients). The most frequent early complication was vertebral endplate injury (5 patients). The most frequent late complication was vertebral body fracture (4 patients). Two patients died as a consequence of their complications.
Conclusion: In our series of patients, the most frequent complications were vascular injury (intraoperative), vertebral endplate injury (early), and vertebral body fracture (late). The author considers that the anterior approach to the lumbar spine performed by a team trained in this type of approach is a safe technique, with a low rate of complications.
Materials and Methods: Descriptive and retrospective study of a series of patients who underwent surgery by an anterior approach to the lumbar spine between 2006 and 2019. The study population was 197 patients. The variables considered were age, gender, diagnosis, surgical plan, lumbar levels involved, and the presence of immediate, early or late complications. The Clavien-Dindo classification was used for surgical complications.
Results: 197 patients were evaluated. The average age was 53.39 years, and there were 106 women (53.81%) and 91 men (46.19%). The most frequent diagnosis was degenerative disc disease in 51 patients (25.89%). 34 patients presented complications (17.26%): 4 immediate complications (2.03%), 22 early complications (11.16%), and 9 late complications (4.57%). The most frequent immediate complication was arterial injury (2 patients). The most frequent early complication was vertebral endplate injury (5 patients). The most frequent late complication was vertebral body fracture (4 patients). Two patients died as a consequence of their complications.
Conclusion: In our series of patients, the most frequent complications were vascular injury (intraoperative), vertebral endplate injury (early), and vertebral body fracture (late). The author considers that the anterior approach to the lumbar spine performed by a team trained in this type of approach is a safe technique, with a low rate of complications.
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How to Cite
Sartor, F. D. (2023). Complications of the Anterior Approach to Lumbar Spine in a Series of 197 Patients. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 88(6), 639-646. https://doi.org/10.15417/issn.1852-7434.2023.88.6.1672
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Clinical Research
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https://doi.org/10.1007/s00268-007-9433-4
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11. Aryan HE, Berven SH, Ames CP. Anterior lumbar interbody fusion (ALIF). En: Ozgur B, Benzel E, Garfin S (eds). Minimally Invasive Spine Surgery. New York, NY: Springer; 2009:143-8. https://doi.org/10.1007/978-0-387-89831-5_17
12. Kaiser MG, Haid RW Jr, Subach BR, Miller JS, Smith CD, Rodts GE Jr. Comparison of the mini-open versus
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13. Regan JJ, Hansen Y, McAfee PC. Laparoscopic fusion of the lumbar spine: minimally invasive spine
surgery: a prospective multicenter study evaluating open and laparoscopic lumbar fusion. Spine (Phila PA
1976)1999;24(4):402-11. https://doi.org/10.1097/00007632-199902150-00023
2. Ito H, Tsuchiya J, Asami G. A new radical operation for Pott’s disease. J Bone Joint Surg 1934;16(3):499-515.
3. Mayer MH. A new microsurgical technique for minimally invasive anterior lumbar interbody fusion. Spine 1997;22(6):691-9. https://doi.org/10.1097/00007632-199703150-00023
4. Mobbs RJ, Phan K, Daly D, Rao PJ, Lennox A. Approach related complications of anterior lumbar interbody fusion: results of a combined spine and vascular surgical team. Global Spine J 2016;6(2):147-54.
https://doi.org/10.1055/s-0035-1557141
5. Camino Willhuber G, Elizondo C, Slullitel P. Analysis of postoperative complications in spinal surgery, hospital length of stay, and unplanned readmission: application of Dindo-Clavien classification to spine surgery. Global Spine J 2019;9(3):279-86. https://doi.org/10.1177/2192568218792053
6. Lazannec JY, del Vecchio R, Ramare S, Mora N, Pouzet B, Saillant G. Revisión y simplificación del abordaje anterior mínimo de la columna lumbar. Rev Ortop Traumatol 2001;3:195-205. Disponible en:
https://www.elsevier.es/es-revista-revista-espanola-cirugia-ortopedica-traumatologia-129-pdf-13015922
7. Pfannenstiel J. Über die Vortheile des suprasymphysären Fascienquerschnitts für die gynäkologischen Köliotomien, zugleich ein Beitrag zu der Indikationsstellung der Operationswege. Breitkopf und Härtel; 1900.
8. Phan K, Hu J, Scherman DB, Rao PJ, Mobbs RJ. Anterior lumbar interbody fusion with and without an “access surgeon”: a systematic review and meta-analysis. Spine (Phila PA 1976) 2017;42(10):E592-E601.
https://doi.org/10.1097/BRS.0000000000001905
9. Brewster L, Trueger N, Schermer C, Ghanayem A, Santaniello J. Infraumbilical anterior retroperitoneal exposure of the lumbar spine in 128 consecutive patients. World J Surg 2008;32(7):1414-9.
https://doi.org/10.1007/s00268-007-9433-4
10. Baker JK, Reardon PR, Reardon MJ, Heggeness MH. Vascular injury in anterior lumbar surgery. Spine (Phila PA 1976)1993;18(15):2227-30. https://doi.org/10.1097/00007632-199311000-00014
11. Aryan HE, Berven SH, Ames CP. Anterior lumbar interbody fusion (ALIF). En: Ozgur B, Benzel E, Garfin S (eds). Minimally Invasive Spine Surgery. New York, NY: Springer; 2009:143-8. https://doi.org/10.1007/978-0-387-89831-5_17
12. Kaiser MG, Haid RW Jr, Subach BR, Miller JS, Smith CD, Rodts GE Jr. Comparison of the mini-open versus
laparoscopic approach for anterior lumbar interbody fusion: a retrospective review. Neurosurgery 2002;51(1):97-105. https://doi.org/10.1227/01.NEU.0000017312.04526.92
13. Regan JJ, Hansen Y, McAfee PC. Laparoscopic fusion of the lumbar spine: minimally invasive spine
surgery: a prospective multicenter study evaluating open and laparoscopic lumbar fusion. Spine (Phila PA
1976)1999;24(4):402-11. https://doi.org/10.1097/00007632-199902150-00023