Article Figures & Data
Figures
- Figure 1
(A) Demarcation for anterior lumbar interbody fusion approach, right L5-S1 level, incision 6-cm long, 3.5 cm above the pubis, and 3.5 cm away from midline. (B) Exposure of the rectus abdominis anterior sheet. (C) The rectus abdominis anterior sheet and fascia transversalis are opened, then the arcuate line of Douglas is incised. (D) Finger dissection of retroperitoneal space with visible retroperitoneal fat.
- Figure 2
(A) The hypogastric plexus is dissected, and the median sacral vessels are coagulated. (B) The exposed L5-S1 disc is released from the vertebral endplates and is removed with a rongeur. (C) The vertebral endplates are prepared, and the zone for arthrodesis is completely exposed. (D) A trial cage is placed in the discectomy zone to define the implant size. Fluoroscopy is performed to confirm depth, position, and lordosis to proceed with the implantation of the cage. Additional grafting materials are added to ensure fusion.
Tables
- Table 1
Case characteristics and vascular complications, age, surgical level, injured structure, lesion treatment, and estimated blood loss.
Case Age, y Surgical Level Injury Treatment Estimated Blood Loss, cc 1 68 L5-S1 Iliolumbar vein NA 10 2 71 L5-S1 NA Electrocoagulation 100 3 68 L5-S1 Left iliac vein Suture, compression, hemostatic, human thrombin 1500 4 55 L5-S1 Iliac vein Bipolar, compression, hemostatic 1000 5 62 L4-L5-S1 Left iliac vein Suture 100 6 58 L4-L5-S1 Iliopelvic vein Compression with gauze and hemostatic 500 7 79 L4-L5-S1 Left iliac vein Suture, compression, hemostatic 450 8 35 L5-S1 Iliac vein Suture 300 9 40 L4-L5-S1 NA Compression, hemostatic 400 Abbreviation: NA, not available.
- Table 2
Case series reports from 1961 to 2019 with vascular injury rate during anterior lumbar interbody fusion procedures.
Reference Year n Arterial Injury,
n (%)Venous Injury,
n (%)Diaz et al 2019 337 0 7 (2.1) Quraishi et al 2013 304 5 (1.6) 19 (6.2) Fantini et al 2007 345 1 (0.3) 9 (2.6) Gumbs et al 2005 64 0 2 (3.1) Brau et al 2004 1315 6 (0.5) 19 (1.4) Kulkarni et al 2003 336 8 (2.4) NA Fritzell et al 2003 72 0 2 (3.7) Holt et al 2003 450 0 7 (1.6) Kaiser et al 2002 98 0 3 (3.1) Oskouian et al 2002 207 2 (0.9) 7 (3.4) Kuslich et al 2000 591 0 10 (1.7) Faciszewski et al 1995 1223 1 (0.1) 3 (0.3) Baker et al 1993 102 0 16 (15.7) Kostuik et al 1983 79 0 2 (2.5) Raugstad et al 1982 47 0 2 (4.3) Harmon et al 1961 250 0 7 (2.8)
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