Access related complications in anterior lumbar surgery performed by spinal surgeons

Purpose Anterior lumbar surgery is a common procedure for anterior lumbar interbody fusion (ALIF) and artificial disc replacement (ADR). Our aim was to study the exposure related complications for anterior lumbar spinal surgery performed by spinal surgeons. Methods A retrospective review was performed for 304 consecutive patients who underwent anterior lumbar spinal surgery over 10 years (2001–2010) at our institution. Each patient’s records were reviewed for patients’ demographics, diagnosis, level(s) of surgery, procedure and complications related to access surgery. Patients undergoing anterior lumbar access for tumour resection, infection, trauma and revision surgeries were excluded. Results All patients underwent an anterior paramedian retroperitoneal approach from the left side. The mean age of patients was 43 years (10–73; 197 males, 107 females). Indications for surgery were degenerative disc disease (DDD 255), degenerative spondylolisthesis (23), scoliosis (18), iatrogenic spondylolisthesis (5) and pseudoarthrosis (3). The procedures performed were single level surgery—L5/S1 ( n = 147), L4/5 ( n = 62), L3/4 ( n = 7); two levels—L4/5 and L5/S1 ( n = 74), L3/4 and L4/5 ( n = 4); three levels—L3/4, L4/5, L5/S1 ( n = 5); four levels—L2/3, L3/4, L4/5, L5/S1 ( n = 5). The operative procedures were single level ADR ( n = 131), a single level ALIF ( n = 87) with or without posterior fusion, two levels ALIF ( n = 54), two levels ADR ( n = 14), a combination of ADR/ALIF ( n = 10), three levels ALIF ( n = 1), three levels ADR/ALIF/ALIF ( n = 1), ADR/ADR/ALIF ( n = 2), four levels ALIF ( n = 1) and finally 3 patients underwent a four level ADR/ADR/ALIF/ALIF. The overall complication rate was 61/304 (20 %). This included major complications (6.2 %)—venous injury requiring suture repair ( n = 14, 4.6 %) and arterial injury ( n = 5 [1.6 %], 3 repaired, 2 thrombolysed). Minor complications (13.8 %) included venous injury managed without repair ( n = 5, 1.6 %), infection ( n = 13, 4.3 %), incidental peritoneal opening ( n = 12, 3.9 %), leg oedema ( n = 2, 0.6 %) and others ( n = 10, 3.3 %). We had no cases of retrograde ejaculation. Conclusion We report a very thorough and critical review of our anterior lumbar access surgeries performed mostly for DDD and spondylolisthesis at L4/5 and L5/S1 levels. Vascular problems of any type (24/304, 7.8 %) were the most common complication during this approach. The incidence of major venous injury requ