Introduction
Evidence & Methods
Depending on the medical center and the surgeons, the anterior approach to the lumbar spine is generally either carried out by a so-called access surgeon (vascular or general surgeon) or by the spine surgeons themselves.
In this single-center retrospective report, spine surgeons performing the approach reported fewer complications, less blood loss, less operative time, and shorter hospital stays compared to when the approach was carried out by a general surgeon. Some complications (such as ileus) were frequently identified in cases involving an access surgeon but were rarely identified in cases treated by spine surgeons alone.
Given the study design (single-center, non-randomized trial with a small number of surgeons), apparent variability in complication reporting (eg, ileus), and the wide variations in surgical training and experience, these data may not be generalized. Surgeons’ skills (general, vascular, or spine) vary, and patient factors complicating exposure should be individually assessed to determine best surgical practice. That said, despite some medico legal fears, it is clear that experienced, skillful spine surgeons can comfortably perform this approach and equally clear that vascular surgeon availability may be prudent.
—The Editors
The anterior approach to the lumbar spine is a relatively versatile exposure that can be used for multiple indications. It can be useful for the treatment of degenerative disc disease, spondylolisthesis, pseudarthrosis, scoliosis, tumor, infection, and fracture [1], [2], [3]. These disorders can be treated accordingly with anterior lumbar interbody fusion, corpectomies or, when appropriate, lumbar disc arthroplasty.
Approaches to the lumbar spine for fusion can be divided into anterior, posterior, and lateral exposures. The anterior approach to the lumbar spine generally is dichotomized between transperitoneal and extraperitoneal dissection [4]. The extraperitoneal approach can be further divided into paramedian and anterolateral access [5]. The complications of anterior spine surgery have been reported previously, and the approach appears to be safe and effective [4], [6], [7].
It seems, however, that anterior lumbar surgery often places a spine surgeon in a territory with which they are unfamiliar [4]. Many spine surgeons use the service of a general surgeon or vascular surgeon to perform the surgical exposure—the so called “access surgeon.” A review of the English-language literature reveals a lack of direct comparisons addressing the perioperative complications of anterior spine surgery performed with and without the assistance of an access surgeon.
The aim of this retrospective review was to investigate two hypotheses regarding the perioperative complications of anterior lumbar spine surgery. Our first hypothesis is that the rates of perioperative complications of anterior lumbar spine surgery would be similar when an access surgeon is used compared with a spine surgeon completing the approach. Our second hypothesis is that it is safe and effective for a spine surgeon to perform the exposure for anterior spine surgery.