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Risk factors for vascular injuries in anterior lumbar interbody fusion: a single-institution retrospective study – Lumbar Fusion

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The article investigates vascular injuries in anterior lumbar interbody fusion (ALIF) procedures, which are often caused by the manipulation of blood vessels for optimal disc space exposure. The study conducted at a large academic center examined intraoperative vascular injuries in patients undergoing single- and multilevel ALIF surgeries. Data analysis revealed that opioid use, multilevel ALIF involving the L2-3 level, and multiple interbodies were independent predictors of vascular injuries in ALIF. Identifying patient risk factors can help reduce the incidence of vascular injuries during ALIF procedures

Summarised by Mr Mo Akmal – Lead Spinal Surgeon
The London Spine Unit : most advanced treatment hospital in London

Published article

S: 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.

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J Neurosurg Spine. 2024 Apr 12:1-7. doi: 10.3171/2024.2.SPINE231349. Online ahead of print. ABSTRACT OBJECTIVE: 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,

J Neurosurg Spine. 2024 Apr 12:1-7. doi: 10.3171/2024.2.SPINE231349. Online ahead of print.

ABSTRACT

OBJECTIVE: 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.

METHODS: 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.

RESULTS: 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).

S: 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.

PMID:38608293 | DOI:10.3171/2024.2.SPINE231349

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Risk factors for vascular injuries in anterior lumbar interbody fusion: a single-institution retrospective study

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J Neurosurg Spine. 2024 Apr 12:1-7. doi: 10.3171/2024.2.SPINE231349. Online ahead of print. ABSTRACT OBJECTIVE: 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

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