Yunga Tigre Joseph, Berry Katherine, Kloehn Andrew J, Lu Victor M, Maddy Krisna, Puerto Aiko, Abdullah Naaman, Burks S Shelby, Levi Allan D
Departments of1Neurological Surgery and.
2Surgery, University of Miami Miller School of Medicine; and.
J Neurosurg Spine. 2024 Apr 12;41(1):17-23. doi: 10.3171/2024.2.SPINE231349. Print 2024 Jul 1.
Vascular injuries in anterior lumbar interbody fusion (ALIF) occur due to the vascular manipulation needed to achieve optimal disc space exposure. In this study, the authors aimed to evaluate intraoperative vascular injuries in patients undergoing single- and multilevel ALIF at a large tertiary academic center.
Prospectively collected data specifically addressing postoperative complications in patients who underwent ALIF by neurosurgery spine faculty working with a specialized vascular surgeon were retrospectively reviewed. Demographic characteristics and intraoperative data were collected. Patients were split into vascular injury and non-vascular injury groups. Outcome comparisons were conducted using the chi-square exact and Wilcoxon rank-sum tests for categorical and continuous data, respectively. Logistic regression was used to investigate associations with vascular injury, with univariate analysis first conducted to identify candidate associations. Based on these results, variables demonstrating a between-groups test statistic of p < 0.10 were included in the multivariate analysis to determine the independent predictors of vascular injuries.
In total, 323 patients who underwent ALIF procedures were identified: 51% were male (n = 166) and 49% were female (n = 157). The mean age was 57.1 years, with 56% (n = 182) having undergone prior lumbar surgery. Vascular injuries were encountered intraoperatively in 7.1% (n = 23) of patients, and the majority (91% [n = 21]) involved the left common iliac vein. Patients with vascular injuries were statistically older (mean 63.6 vs 56.6 years), had greater incidence rates of coronary artery disease, opioid use, multilevel ALIF surgery involving the L2-3 level, and surgery involving multiple disc spaces, had more multilevel anterior instrumentation, and experienced greater blood loss during surgery and longer length of stay (all p < 0.05). Overall, there was 1 death (0.3%) secondary to aortic artery injury. Multivariate analysis identified opioid use, multilevel ALIF involving L2-3, and multiple interbodies as statistically independent predictors of vascular injury (all p < 0.05).
Identifying patient risk factors can reduce the risk of vascular injuries in ALIF. Opioid use, multilevel ALIF involving L2-3, and multiple interbodies were independent predictors of vascular injuries in ALIF.
前路腰椎椎间融合术（ALIF）中的血管损伤是由于为实现最佳椎间盘间隙暴露而进行的血管操作所致。在本研究中，作者旨在评估在一家大型三级学术中心接受单节段和多节段ALIF手术患者的术中血管损伤情况。
回顾性分析由神经外科脊柱专科医生与专业血管外科医生合作，前瞻性收集的接受ALIF手术患者术后并发症的具体数据。收集人口统计学特征和术中数据。将患者分为血管损伤组和非血管损伤组。分别使用卡方精确检验和威尔科克森秩和检验对分类数据和连续数据进行结果比较。采用逻辑回归分析血管损伤的相关因素，首先进行单因素分析以确定候选关联因素。基于这些结果，将组间检验统计量p < 0.10的变量纳入多因素分析，以确定血管损伤的独立预测因素。
共确定323例接受ALIF手术的患者：51%为男性（n = 166），49%为女性（n = 157）。平均年龄为57.1岁，56%（n = 182）的患者曾接受过腰椎手术。7.1%（n = 23）的患者术中发生血管损伤，其中大多数（91% [n = 21]）累及左髂总静脉。发生血管损伤的患者在统计学上年龄更大（平均63.6岁对56.6岁），冠状动脉疾病、使用阿片类药物、涉及L2 - 3节段的多节段ALIF手术、涉及多个椎间盘间隙的手术发生率更高，前路多节段内固定更多，术中失血量更大，住院时间更长（所有p < 0.05）。总体而言，有1例（0.3%）因主动脉损伤死亡。多因素分析确定使用阿片类药物、涉及L2 - 3的多节段ALIF以及多个椎间融合为血管损伤的统计学独立预测因素（所有p < 0.05）。
识别患者风险因素可降低ALIF术中血管损伤的风险。使用阿片类药物、涉及L2 - 3的多节段ALIF以及多个椎间融合是ALIF术中血管损伤的独立预测因素。
