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. 2016 Mar;6(2):147-54.
doi: 10.1055/s-0035-1557141. Epub 2015 Jul 16.

Approach-Related Complications of Anterior Lumbar Interbody Fusion: Results of a Combined Spine and Vascular Surgical Team

Ralph J Mobbs  1 , Kevin Phan  2 , Daniel Daly  3 , Prashanth J Rao  1 , Andrew Lennox  4
Affiliations

Approach-Related Complications of Anterior Lumbar Interbody Fusion: Results of a Combined Spine and Vascular Surgical Team

Ralph J Mobbs et al. Global Spine J. 2016 Mar.

Abstract

Study Design Retrospective analysis of prospectively collected cohort data. Objective Anterior lumbar interbody fusion (ALIF) is a commonly performed procedure for the treatment of degenerative diseases of the lumbar spine. Detailed and comprehensive descriptions of intra- and postoperative complications of ALIF are surprisingly limited in the literature. In this report, we describe our experience with a team model for ALIF and report all complications occurring in our patient series. Methods Patients were prospectively enrolled between January 2009 and January 2013 by a combined spine surgeon and vascular surgeon team. All patients underwent an open ALIF using an anterior approach to the lumbosacral spine. Results From the 227 ALIF cases, mean operative blood loss was 103 mL, ranging from 30 to 900 mL. Mean operative time was 78 minutes. The average length of stay was 5.2 days. Intraoperative vascular injury requiring primary repair with suturing occurred in 15 patients (6.6%). There were 2 cases of postoperative retroperitoneal hematoma. Three patients (1.3%) had incisional hernia requiring revision surgery; 7 (3.1%) patients had prolonged ileus (>7 days) managed conservatively. Four patients described retrograde ejaculation. Sympathetic dysfunction occurred in 15 (6.6%) patients. There were 5 (2.2%) cases of superficial wound infection treated with oral antibiotics, with no deep wound infections requiring reoperation or intravenous therapy. There were no mortalities in this series. Conclusions ALIF is a safe procedure when performed by a combined vascular surgeon and spine surgeon team with acceptably low complication rates. Our series confirms that the team approach results in short operative times and length of stay, with rapid control of intraoperative vessel injury and low overall blood loss.

Keywords: anterior lumbar interbody fusion (ALIF); complications; vascular surgeon.

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Conflict of interest statement

Disclosures Ralph J. Mobbs, Payment for lectures: Stryker Spine, Synthes; Royalties: Stryker Spine; Stock/stock options: Medtronic, J&J; Travel expenses: Orthotec Kevin Phan, none Daniel Daly, none Prashanth J. Rao, none Andrew Lennox, none

Figures

Fig. 1
Fig. 1
(A) L5–S1 approach: horizontal minimal access incision. (B) L3–L4 and L4–L5 approach: midline incision.
Fig. 2
Fig. 2
Synframe retractor (Synthes Spine, Paoli, Pennsylvania, United States).
Fig. 3
Fig. 3
Large retroperitoneal hematoma requiring drainage and exploration.
Fig. 4
Fig. 4
Left common iliac artery: acute occlusion and thrombectomy. Abbreviations: CIA, common iliac artery; ECA, external carotid artery.
See this image and copyright information in PMC

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