Vascular injury in elective anterior lumbosacral surgery

Kirkham B. Wood, John Glenden DeVine, Dena Fischer, Joseph R. Dettori, Michael Janssen

Research output: Contribution to journalArticle

70 Citations (Scopus)

Abstract

Study Design. Systematic review. Objective. To document the incidence and consequences of vascular injury in lumbosacral surgery, to identify factors contributing to this injury, and to determine whether there are any effective measures to decrease the occurrence of vascular injury. Summary of Background Data. Anterior lumbosacral surgery encompasses all aspects of spine surgery, including trauma, deformity, and degenerative conditions. Although it has theoretical advantages, anterior lumbosacral surgery carries with it certain definite risks, one of the most critical of which is injury to the surrounding vasculature. It is important for both the patient and the surgeon to understand the risks, patterns, and outcomes of injury to the vascular structures associated with this surgery. Methods. A systematic review of the English-language literature was undertaken for articles published between January 1993 and December 2008. Electronic databases and reference lists of key articles were searched to identify published studies examining vascular injury in anterior lumbosacral surgery. Vascular injury was defined as any case in which a suture was required to control bleeding. Two independent reviewers assessed the strength of literature using the Grading of Recommendations Assessment, Development, and Evaluation criteria assessing quality, quantity, and consistency of results. Disagreements were resolved by consensus. Results. A total of 88 articles were initially screened, and 40 ultimately met the predetermined inclusion criteria. Vascular injuries after anterior lumbosacral surgeries were rare (<5%). Venous laceration was more common than arterial laceration, and most venous injuries occurred during retraction of the great vessels. In most cases, the overall clinical outcome after vascular injury was not adversely affected. L4-L5 exposure was associated with increased vascular injury in some studies but not others. Vascular injury occurred more frequently in laparoscopic compared with open anterior lumbar interbody fusion. Conclusion. Vascular injury in anterior lumbosacral surgery remains low, with reports being <5%. The consequences of injury seem rare, but may include thrombosis, pulmonary embolism, and prolonged hospitalization. Exposure and surgery at L4-L5 may be associated with a higher risk of injury than that at L5-S1, though the data are not consistent.

Original languageEnglish (US)
JournalSpine
Volume35
Issue numberSUPPL. 9S
DOIs
StatePublished - Apr 1 2010
Externally publishedYes

Fingerprint

Vascular System Injuries
Wounds and Injuries
Lacerations
Pulmonary Embolism
Sutures
Consensus
Hospitalization
Spine
Thrombosis
Language
Databases
Hemorrhage

Keywords

  • Access surgeon
  • Anterior approach
  • Lumbosacral
  • Vascular injury

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine
  • Clinical Neurology

Cite this

Wood, K. B., DeVine, J. G., Fischer, D., Dettori, J. R., & Janssen, M. (2010). Vascular injury in elective anterior lumbosacral surgery. Spine, 35(SUPPL. 9S). https://doi.org/10.1097/BRS.0b013e3181d83411

Vascular injury in elective anterior lumbosacral surgery. / Wood, Kirkham B.; DeVine, John Glenden; Fischer, Dena; Dettori, Joseph R.; Janssen, Michael.

In: Spine, Vol. 35, No. SUPPL. 9S, 01.04.2010.

Research output: Contribution to journalArticle

Wood, KB, DeVine, JG, Fischer, D, Dettori, JR & Janssen, M 2010, 'Vascular injury in elective anterior lumbosacral surgery', Spine, vol. 35, no. SUPPL. 9S. https://doi.org/10.1097/BRS.0b013e3181d83411
Wood, Kirkham B. ; DeVine, John Glenden ; Fischer, Dena ; Dettori, Joseph R. ; Janssen, Michael. / Vascular injury in elective anterior lumbosacral surgery. In: Spine. 2010 ; Vol. 35, No. SUPPL. 9S.
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abstract = "Study Design. Systematic review. Objective. To document the incidence and consequences of vascular injury in lumbosacral surgery, to identify factors contributing to this injury, and to determine whether there are any effective measures to decrease the occurrence of vascular injury. Summary of Background Data. Anterior lumbosacral surgery encompasses all aspects of spine surgery, including trauma, deformity, and degenerative conditions. Although it has theoretical advantages, anterior lumbosacral surgery carries with it certain definite risks, one of the most critical of which is injury to the surrounding vasculature. It is important for both the patient and the surgeon to understand the risks, patterns, and outcomes of injury to the vascular structures associated with this surgery. Methods. A systematic review of the English-language literature was undertaken for articles published between January 1993 and December 2008. Electronic databases and reference lists of key articles were searched to identify published studies examining vascular injury in anterior lumbosacral surgery. Vascular injury was defined as any case in which a suture was required to control bleeding. Two independent reviewers assessed the strength of literature using the Grading of Recommendations Assessment, Development, and Evaluation criteria assessing quality, quantity, and consistency of results. Disagreements were resolved by consensus. Results. A total of 88 articles were initially screened, and 40 ultimately met the predetermined inclusion criteria. Vascular injuries after anterior lumbosacral surgeries were rare (<5{\%}). Venous laceration was more common than arterial laceration, and most venous injuries occurred during retraction of the great vessels. In most cases, the overall clinical outcome after vascular injury was not adversely affected. L4-L5 exposure was associated with increased vascular injury in some studies but not others. Vascular injury occurred more frequently in laparoscopic compared with open anterior lumbar interbody fusion. Conclusion. Vascular injury in anterior lumbosacral surgery remains low, with reports being <5{\%}. The consequences of injury seem rare, but may include thrombosis, pulmonary embolism, and prolonged hospitalization. Exposure and surgery at L4-L5 may be associated with a higher risk of injury than that at L5-S1, though the data are not consistent.",
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AB - Study Design. Systematic review. Objective. To document the incidence and consequences of vascular injury in lumbosacral surgery, to identify factors contributing to this injury, and to determine whether there are any effective measures to decrease the occurrence of vascular injury. Summary of Background Data. Anterior lumbosacral surgery encompasses all aspects of spine surgery, including trauma, deformity, and degenerative conditions. Although it has theoretical advantages, anterior lumbosacral surgery carries with it certain definite risks, one of the most critical of which is injury to the surrounding vasculature. It is important for both the patient and the surgeon to understand the risks, patterns, and outcomes of injury to the vascular structures associated with this surgery. Methods. A systematic review of the English-language literature was undertaken for articles published between January 1993 and December 2008. Electronic databases and reference lists of key articles were searched to identify published studies examining vascular injury in anterior lumbosacral surgery. Vascular injury was defined as any case in which a suture was required to control bleeding. Two independent reviewers assessed the strength of literature using the Grading of Recommendations Assessment, Development, and Evaluation criteria assessing quality, quantity, and consistency of results. Disagreements were resolved by consensus. Results. A total of 88 articles were initially screened, and 40 ultimately met the predetermined inclusion criteria. Vascular injuries after anterior lumbosacral surgeries were rare (<5%). Venous laceration was more common than arterial laceration, and most venous injuries occurred during retraction of the great vessels. In most cases, the overall clinical outcome after vascular injury was not adversely affected. L4-L5 exposure was associated with increased vascular injury in some studies but not others. Vascular injury occurred more frequently in laparoscopic compared with open anterior lumbar interbody fusion. Conclusion. Vascular injury in anterior lumbosacral surgery remains low, with reports being <5%. The consequences of injury seem rare, but may include thrombosis, pulmonary embolism, and prolonged hospitalization. Exposure and surgery at L4-L5 may be associated with a higher risk of injury than that at L5-S1, though the data are not consistent.

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