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• W4256257265 abstract "Anterior exposure of the lumbar spine (ALS) is a safe method to facilitate intervention in patients with spine disorders. Mobilization of vascular structures in patients with prior abdominal or spine interventions can be challenging and lead to significant morbidity. The objective of this study was to evaluate the impact of prior procedures on perioperative vascular complications. We retrospectively reviewed patients undergoing ALS from November 2015 to November 2019 at a single academic referral center. The primary end point was presence of vascular complications (injury and thrombosis). Over the 4-year period, 316 patients underwent ALS, most commonly through a left paramedian approach (54.4%). The most common operative indication was for degenerative disease/deformity (97.5%). A total of 532 levels were exposed, with the most frequent being L5 to S1 (47.7%) and L4 to L5 (32.0%) with 145 (45.9%) patients undergoing multilevel exposure. The mean age was 57 years (range, 19-80 years) with 160 (50.6%) males and a mean body mass index of 30.3 (range, 16.6-44.9). One hundred fifty patients (47.4%) had prior abdominal surgery, and 172 (54.5%) had prior posterior spine surgeries. Nine (2.8%) patients had prior anterior exposures. Intraoperative vascular injuries occurred in 31 (9.8%) patients (26 venous; 5 arterial). Of these, 87.1% occurred during exposures of L4 to L5 and 74.2% during multilevel exposures. In patients with vascular injuries, 80.7% had prior abdominal or posterior spine surgeries in the past. Eighty percent (4/5) of arterial and 88.5% (23/26) of venous injuries involved exposures at L4 to L5. Multilevel exposures accounted for 73.1% of the venous injuries and all but one of the five total arterial injuries. Two vascular injuries required patch repair and the remaining 29 were minor injuries that were primarily repaired. Deep venous thromboses were diagnosed in 25 patients (7.9%) in the perioperative period. Of these, six (24%) had a venous injury repaired intraoperatively. Nineteen patients with deep vein thrombosis (76.0%) had exposures at L4 to L5, with 18 (72.0%) having had multilevel exposure. In total, there were 56 total vascular complications (17.7%) with no arterial thrombosis. There were no perioperative deaths. In this contemporary series, ALS was often performed for multilevel disease with a majority of patients having prior abdominal or spinal procedures. Intraoperative vascular injuries are fortunately minor and readily addressed. However, patients with prior abdominal or spine procedures appear to be the most susceptible to vascular complications. Extra caution should be taken while exposing the L4 to L5 level, especially during multilevel spine exposure." @default.
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• W4256257265 date "2020-07-01" @default.
• W4256257265 modified "2023-09-30" @default.
• W4256257265 title "Contemporary Outcomes of Anterior Spine Exposure: The Influence of Prior Abdominal or Spine Surgery and Exposure Level and Extent" @default.
• W4256257265 doi "https://doi.org/10.1016/j.jvs.2020.04.233" @default.
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