title: Anterior Spinal Surgery Involving Variant Vascular Anatomy: A Case Report.
abstract: METHODS
  Case report of an anterior approach to the spine in the setting of variant vascular anatomy.
  
  
  OBJECTIVE
  To highlight the importance of evaluating vascular anatomy before anterior lumbar spine surgery.
  
  
  BACKGROUND
  A 62-year-old woman with idiopathic scoliosis had thoracolumbar fusion in adolescence and subsequently developed symptomatic sub-adjacent segment breakdown. Vascular complications may be encountered during anterior approaches to the spine. Variation in vascular anatomy may compound the difficulty of an already meticulous dissection.
  
  
  RESULTS
  A patient with idiopathic scoliosis who had thoracolumbar fusion in adolescence and subsequently developed symptomatic sub-adjacent segment breakdown. She underwent a 2-stage posterior/anterior procedure. During the anterior retroperitoneal approach, an anomalous left inferior vena cava was encountered that required tedious dissection for safe and adequate exposure of the lumbar spine.
  
  
  CONCLUSIONS
  When planning anterior lumbar spine surgery, careful review of the vascular anatomy on imaging should be performed. This will help prepare the surgeon for more complex or anomalous anterior anatomy. If atypical vascular anatomy is identified, consideration of a pathologic cause should be investigated.
authors.affiliation: Department of Orthopedics, University of Kansas Medical Center, 3901 Rainbow Boulevard, Mail Stop 3017, Kansas City, KS 66160, USA.
authors.forename: Tanay J
authors.initials: TJ
authors.lastname: Amin
authors.affiliation: Department of Orthopedics, University of Kansas Medical Center, 3901 Rainbow Boulevard, Mail Stop 3017, Kansas City, KS 66160, USA. Electronic address: dburton@kumc.edu.
authors.forename: Douglas C
authors.initials: DC
authors.lastname: Burton
authors.affiliation: Department of Surgery, University of Kansas Medical Center, 3901 Rainbow Boulevard, Mail Stop 3017, Kansas City, KS 66160, USA.
authors.forename: Romano
authors.initials: R
authors.lastname: Delcore
authors.affiliation: Department of Diagnostic Radiology, University of Kansas Medical Center, 3901 Rainbow Boulevard, Mail Stop 3017, Kansas City, KS 66160, USA.
authors.forename: Louis H
authors.initials: LH
authors.lastname: Wetzel
keywords: Anatomic variation; Anterior spinal fusion; Left inferior vena cava; Scoliosis; Vascular