ABSTRACT: Sixty-two consecutive patients undergoing anterior lumbar revision surgery from February 2000 to September 2007 were evaluated for approach strategies and complications.
To determine the incidence of complications in these patients and to make recommendations on future revisions based on the results obtained.
Only 2 articles exist in the literature that address this situation and they have widely varying results in a small number of patients. This larger series may help give more certainty to the expectations for complications in patients undergoing revision anterior lumbar surgery.
A concurrent database was maintained on these 62 consecutive patients. Preoperative strategies were evaluated and complications were tabulated as they occurred and later analyzed to arrive at recommendations for future similar cases.
Twenty-three patients had the same level revised and 39 patients had adjacent levels operated on. There were 3 venous injuries (4.8%), 3 arterial injuries (4.8%), and 1 ureteral injury (1.6%). All 3 arterial injuries occurred while approaching L3-L4 after L4 to S1 prior fusion or disc replacement. All 3 venous injuries and the ureteral injury occurred while approaching a previously operated level or levels. Six of these patients had the injuries repaired and the procedures completed with full recovery. One L5-S1 revision had the procedure aborted after a venous injury. There were no deaths.
Although the incidence of complications in revisions is much greater than for index cases, the actual percentage of venous, arterial, and ureteral complications is certainly acceptable for patients who must have this type of surgery. Only very experienced access surgeons should attempt revision surgery.
Spine 08/2008; 33(15):1662-7. · 2.08 Impact Factor
ABSTRACT: To determine the incidence of left iliac artery thrombosis (LIAT), a prospective database was maintained on 1315 patients undergoing anterior lumbar surgery (ALS) between August 1997 and December 2002. All had distal pulse evaluation preoperatively. In the last 629 cases pulse oxymetry was used to monitor the distal circulation during and after surgery. Patients with pulse deficits or evidence of ischemia after surgery were further analyzed. Six patients were identified with LIAT (0.45%). Five were females and one was male, with ages ranging from 35 to 56 years. All had exposure at the L4-5. Five were diagnosed at surgery and one in the recovery room after posterior surgery. All except one had strong, palpable preoperative pulses. Pulse oxymetry confirmed the diagnosis in two patients, in whom it was not clinically evident. Four had successful thrombectomy; one had a femoro-femoral bypass and one had an axillo-femoral bypass. Two developed compartment syndrome. None had calcifications on preoperative X-rays. LIAT is an uncommon complication of ALS. Early identification and management can avoid long-term complications. Pulse oxymetry helps in its timely identification. Patients undergoing exposure at L4-5 and females are at greater risk.
Annals of Vascular Surgery 02/2004; 18(1):48-51. · 1.03 Impact Factor
ABSTRACT: With the number of anterior lumbar procedures expected to increase significantly over the next few years, it is important for spine surgeons to have a good understanding about the incidence of vascular complications during these operations.
To determine the incidence of vascular injury in 1,315 consecutive cases undergoing anterior lumbar surgery at various levels from L2 to S1.
Patients undergoing anterior lumbar surgery were studied.
A total of 1,310 consecutive patients undergoing 1,315 anterior lumbar procedures between August 1997 and December 2002 were included in the study.
All patients were evaluated for incidence of vascular injury during and immediately after surgery.
A concurrent database was maintained on all these cases. All the patients had distal pulse evaluation preoperatively. Patients with venous injuries were further analyzed to determine location and extent of injury, amount of blood loss, completion of the procedure and postoperative sequelae. Patients with pulse deficits or evidence of ischemia during or immediately after surgery were further analyzed in particular in relation to demographic, preoperative variables and management.
Six patients were identified as having left iliac artery thrombosis (0.45%), and 19 had major vein lacerations (1.4%).
This study shows that the incidence of vascular injury is relatively low (25 in 1,315 or 1.9%). Because only five of these patients experienced significant sequelae from the approach, it appears that anterior lumbar surgery is quite safe, although it must be carried out with utmost respect for the vessels to avoid possible catastrophic outcomes.
The Spine Journal 4(4):409-12. · 3.29 Impact Factor