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Complications of the Anterior Approach to the Lumbar Spine

Introduction Lumbar spine pathology, such as tumors and fractures, commonly affect vertebral bodies, making anterior access to the spine an important tool in the armamentarium of spinal surgeons. Furthermore, accessing the front of the spine via a posterior approach is associated with the potential for neural injury. Reports in the literature of high rates of complications, particularly vascular injury, has led to questions about the safety of the anterior lumbar approach. As a result, various recommendations have been made such as the used of “access” surgeons and ring retractor systems to reduce the complication rate. We present the complication rates from over 550 anterior approaches performed in Exeter, United Kingdom, by multiple surgeons over an 18-year period, without the use of an access surgeon or ring retractor system. Materials and Methods We retrospectively reviewed the notes of 567 consecutive patients having undergone an anterior approach to the lumbar spine for any procedure from 1996 to 2014. Information was collected from operation notes, anesthetic records, postoperative ward rounds, and clinic letters. Details were recorded on intraoperative blood loss and complications such as vascular injury and peritoneal opening as well as postoperative complications such as infection, DVT/PE, ileus, and hernias. Results There was an overall complication rate of 13.4%. The rate of vascular injury requiring suture repair was 3.2% and the rate requiring input from a vascular surgeon 0.8%. Conclusion We report a comprehensive and critical review of our practice over 18-years with a large series of consecutive patients undergoing anterior lumbar surgery for a wide range of pathology. This has been performed in a single center by multiple orthopedic spinal surgeons without the use of access surgeons or dedicated ring retractor systems. Our complication rates have been shown to be comparable to the existing literature demonstrating that in high volume centers the anterior approach to the lumbar spine is safe and effective for a multitude of applications.