Abstract
Purpose
This article examines the incidence and management of vascular injury during Lateral Lumbar Interbody Fusion (LLIF). The details of the mini-open access technique are presented.
Methods
A total of 900 patients who underwent a LLIF at an average 1.94 levels (range: 1–5 levels) by one of six fellowship trained surgeons on 1,754 levels from 2006 to 2013 were identified. The incidence of intraoperative vascular injury was retrospectively determined from the Operative Records. The management of vascular injury was evaluated. The mini-open access adapted by our institution for LLIF is described.
Results
The incidence of major vascular complication in our series was 1/900. The incidence of minor vascular injury was 4/900. The overall incidence of vascular injury was calculated to be 0.056 % per case and 0.029 % per level. All minor vascular injuries were identified to be segmental vessel lacerations, which were readily ligated under direct visualization without further extension of the incision with no clinical sequelae. The laceration of the abdominal aorta, the major vascular complication of this series, was emergently repaired through an exploratory laparotomy. None of the patients suffered long-term sequelae from their intraoperative vascular injuries.
Conclusions
The mini-open lateral access technique for LLIF provides for minimal risk of vascular injury to the lumbar spine. In the rare event of minor vascular injury, the mini-open access approach allows for immediate visualization, confirmation and repair of the vessel with no long-term sequelae.
Similar content being viewed by others
References
Ozgur BM, Aryan HE, Pimenta L, Taylor WR (2006) Extreme Lateral Interbody Fusion (XLIF): a novel surgical technique for anterior lumbar interbody fusion. Spine J 6(4):435–443
Youssef JA, McAfee PC, Patty CA et al (2010) Minimally invasive surgery: lateral approach interbody fusion: results and review. Spine (Phila Pa 1976) 35(26 Suppl):S302–S311. doi:10.1097/BRS.0b013e3182023438
Aghayev K, Vrionis FD (2013) Mini-open lateral retroperitoneal lumbar spine approach using psoas muscle retraction technique. Technical report and initial results on six patients. Eur Spine J 22(9):2113–2119. doi:10.1007/s00586-013-2931-1
Yuan PS, Rowshan K, Verma RB, Miller LE, Block JE (2014) Minimally invasive lateral lumbar interbody fusion with direct psoas visualization. J Orthop Surg Res 9(1):20. doi:10.1186/1749-799X-9-20
Hardenbrook MA, Miller LE, Block JE (2013) TranS1 VEO system: a novel psoas-sparing device for transpsoas lumbar interbody fusion. Med Devices (Auckl) 6:91–95. doi:10.2147/MDER.S43746
Pumberger M, Hughes AP, Huang RR et al (2012) Neurologic deficit following lateral lumbar interbody fusion. Eur Spine J 21(6):1192–1199. doi:10.1007/s00586-011-2087-9
Taher F, Hughes AP, Lebl DR et al (2013) Contralateral motor deficits after lateral lumbar interbody fusion. Spine (Phila Pa 1976) 38(22):1959–1963. doi:10.1097/BRS.0b013e3182a463a9
Lykissas MG, Aichmair A, Hughes AP et al (2014) Nerve injury after lateral lumbar interbody fusion: a review of 919 treated levels with identification of risk factors. Spine J 14(5):749–758. doi:10.1016/j.spinee.2013.06.066
Fantini GA, Pawar AY (2013) Access related complications during anterior exposure of the lumbar spine. World J Orthop 4(1):19–23. doi:10.5312/wjo.v4.i1.19
Aichmair A, Fantini GA, Garvin S, Beckman J, Girardi FP (2013) Aortic perforation during lateral lumbar interbody fusion. J Spinal Disord Tech [Epub ahead of print]
Rodgers WB, Gerber EJ, Patterson J (2011) Intraoperative and early postoperative complications in extreme lateral interbody fusion: an analysis of 600 cases. Spine (Phila Pa 1976) 36(1):26–32. doi:10.1097/BRS.0b013e3181e1040a
Prince EA, Ahn SH (2013) Basic vascular neuroanatomy of the brain and spine: what the general interventional radiologist needs to know. Semin Intervent Radiol 30(3):234–239. doi:10.1055/s-0033-1353475
Shimizu S, Tanaka R, Kan S et al (2005) Origins of the segmental arteries in the aorta: an anatomic study for selective catheterization with spinal arteriography. AJNR Am J Neuroradiol 26(4):922–928
Berenstein A, Lasjaunias P, Ter Brugge KG (2001) Spinal and spinal cord arteries and veins. In: Berenstein A, Lasjaunias P, Ter Brugge KG (eds) Surgical neuroangiography. Clinical vascular anatomy and variations, vol 2nd. Springer, New York, pp 73–164
Kao FC, Tsai TT, Chen LH, et al (2014) Symptomatic epidural hematoma after lumbar decompression surgery. Eur Spine J [Epub ahead of print]
Amiri AR, Fouyas IP, Cro S, Casey AT (2013) Postoperative spinal epidural hematoma (SEH): incidence, risk factors, onset, and management. Spine J 13(2):134–140. doi:10.1016/j.spinee.2012.10.028
Regan JJ, Aronoff RJ, Ohnmeiss DD, Sengupta DK (1999) Laparoscopic approach to L4-L5 for interbody fusion using BAK cages: experience in the first 58 cases. Spine (Phila Pa 1976) 24(20):2171–2174
Khajavi K, Shen AY (2014) Two-year radiographic and clinical outcomes of a minimally invasive, lateral, transpsoas approach for anterior lumbar interbody fusion in the treatment of adult degenerative scoliosis. Eur Spine J 23(6):1215–1223. doi:10.1007/s00586-014-3246-6
Smith AG, Capobianco R, Cher D et al (2013) Open versus minimally invasive sacroiliac joint fusion: a multi-center comparison of perioperative measures and clinical outcomes. Ann Surg Innov Res 7(1):14. doi:10.1186/1750-1164-7-14
Singh K, Nandyala SV, Marquez-Lara A et al (2013) A perioperative cost analysis comparing single-level minimally invasive and open transforaminal lumbar interbody fusion. Spine J 13:01723–01733. doi:10.1016/j.spinee.2013.10.053
Kaiser MG, Haid RW Jr, Subach BR et al (2002) Comparison of the mini-open versus laparoscopic approach for anterior lumbar interbody fusion: a retrospective review. Neurosurgery 51(1):97–103 (discussion 103-5)
Rajaraman V, Vingan R, Roth P et al (1999) Visceral and vascular complications resulting from anterior lumbar interbody fusion. J Neurosurg 91(1 Suppl):60–64
Baker JK, Reardon PR, Reardon MJ, Heggeness MH (1993) Vascular injury in anterior lumbar surgery. Spine (Phila Pa 1976) 18(15):2227–2230
Flynn JC, Price CT (1984) Sexual complications of anterior fusion of the lumbar spine. Spine (Phila Pa 1976) 9(5):489–492
Fantini GA, Pappou IP, Girardi FP, Sandhu HS, Cammisa FP Jr (2007) Major vascular injury during anterior lumbar spinal surgery: incidence, risk factors, and management. Spine (Phila Pa 1976) 32(24):2751–2758
Conflict of interest
There were no sources of financial support or perceived conflicts of interest for this study.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Kueper, J., Fantini, G.A., Walker, B.R. et al. Incidence of vascular complications during lateral lumbar interbody fusion: an examination of the mini-open access technique. Eur Spine J 24, 800–809 (2015). https://doi.org/10.1007/s00586-015-3796-2
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00586-015-3796-2