Vascular injury during anterior lumbar surgery.
BACKGROUND
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.


OBJECTIVE
To determine the incidence of vascular injury in 1,315 consecutive cases undergoing anterior lumbar surgery at various levels from L2 to S1.


METHODS
Patients undergoing anterior lumbar surgery were studied.


METHODS
A total of 1,310 consecutive patients undergoing 1,315 anterior lumbar procedures between August 1997 and December 2002 were included in the study.


METHODS
All patients were evaluated for incidence of vascular injury during and immediately after surgery.


METHODS
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.


RESULTS
Six patients were identified as having left iliac artery thrombosis (0.45%), and 19 had major vein lacerations (1.4%).


CONCLUSIONS
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.
Brau
Salvador A
SA
Spine Access Surgery Associates, 1334 Westwood Boulevard, Suite 1D, Los Angeles, CA 90024, USA. salvo@labridge.com
Delamarter
Rick B
RB
Schiffman
Michael L
ML
Williams
Lytton A
LA
Watkins
Robert G
RG
D015331:Cohort Studies; D019299:Decompression, Surgical / Q000009:adverse effects* / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007083:Iliac Artery / Q000293:injuries; D007084:Iliac Vein / Q000293:injuries; D015994:Incidence; D007431:Intraoperative Complications / Q000175:diagnosis* / Q000453:epidemiology; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D012189:Retrospective Studies; D018570:Risk Assessment; D013123:Spinal Fusion / Q000009:adverse effects* / Q000379:methods; D013927:Thrombosis / Q000453:epidemiology / Q000209:etiology*; D014652:Vascular Diseases / Q000453:epidemiology / Q000209:etiology*