title: Incidence of vascular complications arising from anterior spinal surgery in the thoraco-lumbar spine.
abstract: METHODS
  Modern biomaterials and instrumentation have popularised surgery of the thoraco-lumbar spine through an anterior route. The advantage of anterior surgery is that it allows for a direct decompression of the compromised spinal canal. However, the potential for devastating long-term sequelae as a result of complications is high.
  
  
  OBJECTIVE
  The aim of this study was to give a general overview and identify the incidence of vascular complications.
  
  
  BACKGROUND
  There is limited literature describing the overall incidence and complications of anterior spinal surgery.
  
  
  METHODS
  A retrospective review of a prospective database of 1,262 consecutive patients with anterior surgery over a twelve-year period.
  
  
  RESULTS
  In our study, 1.58% (n=20) of patients suffered complications. Injury to a major vessel was encountered in 14 (1.11%) cases, of which nine involved an injury to the common iliac vein. In six cases, the original procedure was abandoned due to a life-threatening vascular injury (n=3) and unfavourable anatomy (n=3).
  
  
  CONCLUSIONS
  The incidence of vascular and other complications in our study was relatively low. Nevertheless, the potential for devastating long-term sequelae as a result of complications remains high. A thorough knowledge and awareness of normal and abnormal anatomy should be gained before attempting such a procedure, and a vascular surgical assistance especially should be readily accessible. We believe use of access surgeons is mandatory in cases with difficult or aberrant anatomy.
authors.affiliation: Department of Trauma and Orthopaedics, Royal Derby Hospital, Derby, UK. ; Department of Spinal Surgery, Charles University Medical School, Prague, Czech Republic.
authors.forename: Zdenek
authors.initials: Z
authors.lastname: Klezl
authors.affiliation: Department of Trauma and Orthopaedics, Royal Derby Hospital, Derby, UK.
authors.forename: Girish Nanjunda
authors.initials: GN
authors.lastname: Swamy
authors.affiliation: Department of Spinal Surgery, Charles University Medical School, Prague, Czech Republic.
authors.forename: Thomas
authors.initials: T
authors.lastname: Vyskocil
authors.affiliation: Department of Spinal Surgery, Charles University Medical School, Prague, Czech Republic.
authors.forename: Jan
authors.initials: J
authors.lastname: Kryl
authors.affiliation: Department of Spinal Surgery, Charles University Medical School, Prague, Czech Republic.
authors.forename: Jan
authors.initials: J
authors.lastname: Stulik
keywords: Anterior thoraco-lumbar approach; Complications; External iliac vein; Left iliac vein; Vascular injury