title: Anterior exposure of the lumbar spine with and without an "access surgeon": morbidity analysis of 265 consecutive cases.
abstract: METHODS
  Retrospective review
  
  
  OBJECTIVE
  To compare the incidence and type of exposure-related complications for anterior lumbar surgery performed with and without an "access" surgeon.
  
  
  BACKGROUND
  No data exist comparing the incidence and type of exposure-related complications for anterior lumbar surgery performed with and without a vascular surgeon's assistance.
  
  
  METHODS
  A retrospective review was performed for 265 consecutive patients who underwent anterior lumbar spine surgery at our institution from 2003 to 2005. Each patient's records were reviewed for diagnosis, procedure, whether the surgical exposure was conducted by the spine surgeon (Spine) or with a vascular surgeon's assistance (Team), levels exposed, complications, and any lasting sequelae.
  
  
  RESULTS
  The percentage of patients with at least 1 intraoperative complication was 8% and 12% for the Spine and Team cases, respectively. Two percent of the Spine patients experienced an intraoperative vascular complication compared with 7% of the Team cases. No intraoperative vascular complication occurred in the single-level Spine exposures. Four percent of the patients with single-level exposures with Team approaches sustained an intraoperative vascular complication. Eight percent of the multilevel Spine cases sustained an intraoperative vascular complication compared with 9% of the multilevel Team exposures. There were 14 vascular injuries appreciated intraoperatively in a total of 13 patients. These injuries were directly repaired in 10 patients without any residual sequelae. The rate of vascular complications was statistically higher for multiple-level exposures (9%) versus single-level exposure (3%; P = 0.0357). The rate of retrograde ejaculation was 6% in the Spine cases whereas it was 7% in the Team approach.
  
  
  CONCLUSIONS
  Our results do not support the notion that the presence of an "access" surgeon will change the type and rate of complications. With adequate training and judgment, spine surgeons may safely perform such exposures, provided vascular surgical assistance is readily available.
authors: Department of Orthopaedic Surgery, Emory Spine Center, Emory University School of Medicine, 59 Executive Park South Dr, Atlanta, GA 30329, USA. claudedjarrett@yahoo.com
authors: Claudius D
authors: CD
authors: Jarrett
authors: John G
authors: JG
authors: Heller
authors: Luke
authors: L
authors: Tsai
mesh_terms: D034841:Abdominal Cavity / Q000033:anatomy & histology / Q000601:surgery; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001012:Aorta, Abdominal / Q000033:anatomy & histology / Q000293:injuries; D016063:Blood Loss, Surgical; D001808:Blood Vessels / Q000033:anatomy & histology / Q000293:injuries*; D017586:Diskectomy / Q000009:adverse effects / Q000379:methods / Q000401:mortality; D007172:Erectile Dysfunction / Q000209:etiology / Q000401:mortality / Q000517:prevention & control; D005260:Female; D006801:Humans; D007083:Iliac Artery / Q000033:anatomy & histology / Q000293:injuries; D015994:Incidence; D007431:Intraoperative Complications / Q000209:etiology / Q000401:mortality* / Q000517:prevention & control; D008159:Lumbar Vertebrae / Q000033:anatomy & histology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000009:adverse effects* / Q000379:methods / Q000401:mortality*; D010348:Patient Care Team / Q000706:statistics & numerical data*; D019106:Postoperative Hemorrhage / Q000209:etiology / Q000401:mortality / Q000517:prevention & control; D012187:Retroperitoneal Space / Q000033:anatomy & histology / Q000601:surgery; D012189:Retrospective Studies; D013123:Spinal Fusion / Q000009:adverse effects / Q000379:methods / Q000401:mortality; D017779:Sympathetic Fibers, Postganglionic / Q000033:anatomy & histology / Q000293:injuries; D055815:Young Adult