Incidence of vascular complications arising from anterior spinal surgery in the thoraco-lumbar spine.

STUDY DESIGN

Modern biomaterials and instrumentation have popularised surgery of the thoraco-lumbar spine through an anterior route. The advantage of anterior surgery is that it allows for a direct decompression of the compromised spinal canal. However, the potential for devastating long-term sequelae as a result of complications is high.

PURPOSE

The aim of this study was to give a general overview and identify the incidence of vascular complications.

OVERVIEW OF LITERATURE

There is limited literature describing the overall incidence and complications of anterior spinal surgery.

METHODS

A retrospective review of a prospective database of 1,262 consecutive patients with anterior surgery over a twelve-year period.

RESULTS

In our study, 1.58% (n=20) of patients suffered complications. Injury to a major vessel was encountered in 14 (1.11%) cases, of which nine involved an injury to the common iliac vein. In six cases, the original procedure was abandoned due to a life-threatening vascular injury (n=3) and unfavourable anatomy (n=3).

CONCLUSIONS

The incidence of vascular and other complications in our study was relatively low. Nevertheless, the potential for devastating long-term sequelae as a result of complications remains high. A thorough knowledge and awareness of normal and abnormal anatomy should be gained before attempting such a procedure, and a vascular surgical assistance especially should be readily accessible. We believe use of access surgeons is mandatory in cases with difficult or aberrant anatomy.