Institut du Rachis, Service de Chirurgie Orthopédique et Traumatologique, Hôpital Henri Mondor, AP-HP, UPEC, 51, Avenue du Maréchal de Lattre de Tassigny, 94010 Creteil Cedex, France.
Eur Spine J. 2013 Apr;22(4):766-74. doi: 10.1007/s00586-012-2524-4. Epub 2012 Oct 1.
After a first anterior approach to the lumbar spine, formation of adhesions of soft tissues to the spine increases the surgical difficulties and potential for iatrogenic injury during the revision exposure. The objective of this study was to identify the intraoperative difficulties and postoperative complications associated with revision anterior lumbar spine procedures in a single institution.
This is a retrospective review of 25 consecutive anterior revision lumbar surgeries in 22 patients (7 men and 15 women) operated on between 1998 and 2011. Patients with trauma or malignancies were excluded. The mean age of the patients at the time of revision surgery was 56 years (range 20-80 years). The complications were analyzed depending on the operative level and the time between the index surgery and the revision.
Six major complications (five intraoperatively and one postoperatively) occurred in five patients (20 %): three vein lacerations (12 %) and two ureteral injuries (8 %), despite the presence of a double-J ureteral stent. The three vein damages were repaired or ligated by a vascular surgeon. One of the two ureteral injuries led to a secondary nephrectomy after end-to-end anastomosis failure; the other necessitated secondary laparotomy for small bowel obstruction.
Anterior revision of the lumbar spine is technically challenging and is associated with a high rate of vascular or urologic complications. Therefore, the potential complications of the procedure must be weighted against its benefits. When iterative anterior lumbar approach is mandatory, exposure should be performed by an access surgeon in specialized centers that have ready access to vascular and urologic surgeons.
腰椎前路初次手术后，软组织与脊柱的粘连增加了手术难度，并可能导致翻修暴露时的医源性损伤。本研究的目的是在一个机构内确定与腰椎前路翻修手术相关的术中困难和术后并发症。
这是对 1998 年至 2011 年间连续 25 例 22 例患者（7 名男性和 15 名女性）行前路腰椎翻修手术的回顾性研究。排除创伤或恶性肿瘤患者。翻修手术时患者的平均年龄为 56 岁（范围 20-80 岁）。根据手术水平和索引手术与翻修之间的时间，分析并发症。
5 例患者（20%）发生 6 例重大并发症（5 例术中，1 例术后）：3 例静脉撕裂（12%）和 2 例输尿管损伤（8%），尽管存在双 J 输尿管支架。3 例静脉损伤由血管外科医生修复或结扎。2 例输尿管损伤中，1 例因端端吻合失败导致继发性肾切除术；另 1 例因小肠梗阻需要再次剖腹手术。
腰椎前路翻修技术难度大，血管或泌尿科并发症发生率高。因此，必须权衡手术的潜在并发症与其益处。当必须进行反复前路腰椎手术时，应在有血管和泌尿科外科医生的专门中心由接入外科医生进行暴露。
