title: A team approach to anterior lumbar spine surgery in the military.
abstract: We report a five year military experience with anterior retroperitoneal spine exposure combining vascular and neurosurgical spine teams. From August 2005 through April 2010 (56 months), hospital records from a single institution were retrospectively reviewed. Complications, estimated blood loss, transfusions, operative time and length of stay were documented. Eighty-four patients with lumbar spondylosis underwent primary (63, 75%) or secondary exposure (21, 25%) of a single- (66, 79%) or multilevel disc space (18, 21%). Median operative time and estimated blood loss were 127 minutes (range, 30-331 minutes) and 350 mL (range, 0-2940 mL). The overall complication rate was 23.8%. Postoperative complications included six blood transfusions (7%), three patients with retrograde ejaculation (3.57%) or surgical site infection; two with a prolonged ileus (2.38%) or ventral hernia and one each with a bowel obstruction (1, 1.19%), deep venous thrombosis or lymphocele. All-cause mortality was 1%. In conclusion, a team approach can minimize complications while offering the technical benefits and durability of an anterior approach to the lumbar spine.
authors.affiliation: Department of Surgery, Medical College of Wisconsin, Milwaukee, WI; Center for Translational Injury Research (CeTIR), Department of Surgery, University of Texas-Houston.
authors.forename: Anahita
authors.initials: A
authors.lastname: Dua
authors.affiliation: Department of Surgery, Division of Vascular Surgery.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Fox
authors.affiliation: Department of Surgery, Division of Vascular Surgery.
authors.forename: Bhavin
authors.initials: B
authors.lastname: Patel
authors.affiliation: Department of Surgery, Division of Vascular Surgery.
authors.forename: Eric
authors.initials: E
authors.lastname: Martin
authors.affiliation: Department of Surgery, Neurosurgery Service, Walter Reed National Military Medical Center Norman M. Rich Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Rosner
authors.affiliation: Department of Surgery, Division of Vascular Surgery Norman M. Rich Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD, USA foxvascular@gmail.com.
authors.forename: Charles J
authors.initials: CJ
authors.lastname: Fox
mesh_terms: D000328:Adult; D000368:Aged; D003299:Cooperative Behavior; D005260:Female; D006801:Humans; D033183:Interdisciplinary Communication; D007902:Length of Stay; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D008887:Military Medicine / Q000379:methods*; D019635:Neurosurgical Procedures / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D019637:Orthopedic Procedures / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D010348:Patient Care Team; D011183:Postoperative Complications / Q000175:diagnosis / Q000628:therapy; D012189:Retrospective Studies; D013122:Spinal Diseases / Q000401:mortality / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D055815:Young Adult
keywords: anterior retroperitoneal approach; spinal fusion; spine surgery; vascular trauma