Analysis of intraoperative difficulties and management of operative complications in revision anterior exposure of the lumbar spine: a report of 25 consecutive cases.
OBJECTIVE
After a first anterior approach to the lumbar spine, formation of adhesions of soft tissues to the spine increases the surgical difficulties and potential for iatrogenic injury during the revision exposure. The objective of this study was to identify the intraoperative difficulties and postoperative complications associated with revision anterior lumbar spine procedures in a single institution.


METHODS
This is a retrospective review of 25 consecutive anterior revision lumbar surgeries in 22 patients (7 men and 15 women) operated on between 1998 and 2011. Patients with trauma or malignancies were excluded. The mean age of the patients at the time of revision surgery was 56 years (range 20-80 years). The complications were analyzed depending on the operative level and the time between the index surgery and the revision.


RESULTS
Six major complications (five intraoperatively and one postoperatively) occurred in five patients (20 %): three vein lacerations (12 %) and two ureteral injuries (8 %), despite the presence of a double-J ureteral stent. The three vein damages were repaired or ligated by a vascular surgeon. One of the two ureteral injuries led to a secondary nephrectomy after end-to-end anastomosis failure; the other necessitated secondary laparotomy for small bowel obstruction.


CONCLUSIONS
Anterior revision of the lumbar spine is technically challenging and is associated with a high rate of vascular or urologic complications. Therefore, the potential complications of the procedure must be weighted against its benefits. When iterative anterior lumbar approach is mandatory, exposure should be performed by an access surgeon in specialized centers that have ready access to vascular and urologic surgeons.
Institut du Rachis, Service de Chirurgie Orthopédique et Traumatologique, Hôpital Henri Mondor, AP-HP, UPEC, 51, Avenue du Maréchal de Lattre de Tassigny, 94010 Creteil Cedex, France. charles-henri.flouzat-lachaniette@hmn.aphp.fr
Charles-Henri
CH
Flouzat-Lachaniette
William
W
Delblond
Alexandre
A
Poignard
Jérôme
J
Allain
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019468:Disease Management; D005260:Female; D006801:Humans; D015994:Incidence; D007431:Intraoperative Complications / Q000453:epidemiology* / Q000601:surgery*; D007813:Laparotomy; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy; D011183:Postoperative Complications / Q000453:epidemiology* / Q000601:surgery*; D012086:Reoperation / Q000009:adverse effects; D012189:Retrospective Studies; D013123:Spinal Fusion / Q000009:adverse effects*; D059145:Total Disc Replacement / Q000009:adverse effects*; D014513:Ureter / Q000293:injuries / Q000601:surgery; D014656:Vascular Surgical Procedures; D014680:Veins / Q000293:injuries / Q000601:surgery