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. 2024 Oct-Dec;15(4):437-442.
doi: 10.4103/jcvjs.jcvjs_134_24. Epub 2025 Jan 15.

Does structural compromise of the aorta in patients with aortic pathologies predict increased spinal and vascular complications and reoperations in patients undergoing anterior approach to the spine?

Neil V Shah  1 , Pelin Çeliker  1 , Cirous Sadeghi  2 , Rachel Baum  1 , Juhayer S Alam  1 , Chibuokem Ikwuazom  1 , Peter L Zhou  1 , Benjamin Krasnyanskiy  1 , David Kim  1 , Rohan Desai  1   3 , Sandeep Bains  4 , Jeffrey M Schwartz  5 , Bassel G Diebo  1   6 , Carl B Paulino  1   7
Affiliations

Does structural compromise of the aorta in patients with aortic pathologies predict increased spinal and vascular complications and reoperations in patients undergoing anterior approach to the spine?

Neil V Shah et al. J Craniovertebr Junction Spine. 2024 Oct-Dec.

Abstract

Objectives: Anterior spinal fusion (ASF) presents unique challenges, including the proximity of critical anatomic structures. Previous reports have detailed vascular injuries during exposure/approach; however, it is not well-documented whether structural aortic pathology, such as aneurysm, dissection, atherosclerosis, aortitis, or aortic tumors, impacts postoperative outcomes following anterior approach to the spine for spinal fusion.

Materials and methods: Using the New York State Statewide Planning and Research Cooperative System, thoracolumbar ASF patients with a history of aneurysm, dissection, atherosclerosis, aortitis, or aortic tumors (APath) were identified and matched to patients with no aortic pathologies (No-APath). The two cohorts were compared at 90-day and 2-year follow-up for complications, readmissions, and revisions. Multivariate binary stepwise logistic regression identified independent predictors of these outcomes.

Results: Ninety-nine and 64 patients were included at 90-day and 2-year follow-ups, respectively. APath and No-APath had comparable demographics. Through 90-day follow-up, both cohorts had similar vascular complications and overall complications. No-APath patients had higher surgical complications (11.1% vs. 0%, P = 0.021). At 2-year follow-up, cohorts had comparable vascular complications, overall complications, and all other outcomes (P > 0.05). Neither group was observed to require any revisions through 2-year follow-up. The presence of a structural aortic pathology was not associated with increased odds of incurring adverse outcomes at 90-day and 2-year follow-ups.

Conclusions: Structural aortic compromise in the setting of thoracolumbar ASF did not predispose patients to adverse vascular, spinal-related, or medical/surgical complications, nor to anterior spinal or vascular revision or repair through 2-year follow-up. These results highlight the need for well-powered studies to further delineate the risk of anterior spinal surgery in this cohort of patients.

Keywords: Aorta; complications; fusion; spine; thoracolumbar.

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Conflict of interest statement

Bassel G. Diebo - Certifies receipt of personal payments or benefits, during the study period, in an amount of USD 10,000 to USD 100,000 from Clariance; in an amount of USD 10,000 to USD 100,000 from Spineart; and in an amount of USD 10,000 to USD 100,000 from Spinevision. One of the authors (BGD) certifies receipt of grant support in an amount of USD 10,000 to USD 100,000 from Alphatec; and in an amount of USD 10,000 to USD 100,000 from Medtronic. The remainder of the authors have no conflicts of interests to report.

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