Anterior lumbar spine exposure with vascular surgeon assistance

Objective:Evaluate access related complications contributing to adverse outcomes in patients undergoing retroperitoneal anterior lumbar interbody fusion (ALIF). MethodsA retrospective analysis was conducted of prospectively collected data on patients undergoing ALIF in a multidisciplinary setting at our institution from January 2007 to December 2021. Patients’ demographics, comorbidities, exposure related and postoperative complications within 30 days were included. Main outcome measures included vascular and visceral injuries requiring repair, nerve injuries, blood transfusion requirements, myocardial infarction, stroke, erectile dysfunction, retrograde ejaculation, length of stay and death. ResultsSeventy-four consecutive patients were included. Forty-seven were female and 27 male. The median body mass index was of 25.46 ± 4.76. Mean age was of 45.74 years. Twelve had a history of previous abdominal surgery and 31 a previous spinal surgery. The level operated on was L5/S1 in 58 patients (78.37%), L4/L5 in 2 patients (2.7%) and multi-level in 14 patients (18.91%). Sixteen patients had both anterior and posterior approach. There were no major intra-operative vascular injuries. Two patients had an intestine serosal tear. Seven patients had sexual dysfunction after surgery, of which 5 suffered impotence and 4 retrograde ejaculation. Two patients had both. There were no cases of disc space infections. There were no postoperative deaths. ConclusionsIn a multidisciplinary setting, ALIF can be performed safely with a reasonably low overall complication rate. Impotence and retrograde ejaculation are, even if generally temporary, important issues that have to be informed to the patient and inquired at follow up.