Incidence of major and minor vascular injuries during lateral access lumbar interbody fusion procedures: a retrospective comparative study and systematic literature review

December 2, 2021

Review

doi: 10.1007/s10143-021-01699-8.

Online ahead of print.

Affiliations

¹ Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo, NY, USA.
² Department of Neurosurgery, Faculty of Medicine, Cairo University, Cairo, Egypt.
³ Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, 100 High Street, Suite B4, Buffalo, NY, 14203, USA.
⁴ Department of Neurosurgery, Buffalo General Medical Center, Kaleida Health, Buffalo, NY, USA.
⁵ Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, 100 High Street, Suite B4, Buffalo, NY, 14203, USA. [email protected].
⁶ Department of Neurosurgery, Buffalo General Medical Center, Kaleida Health, Buffalo, NY, USA. [email protected].

Item in Clipboard

Review

Alexander O Aguirre et al.

Neurosurg Rev.

2021.

doi: 10.1007/s10143-021-01699-8.

Online ahead of print.

Affiliations

¹ Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo, NY, USA.
² Department of Neurosurgery, Faculty of Medicine, Cairo University, Cairo, Egypt.
³ Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, 100 High Street, Suite B4, Buffalo, NY, 14203, USA.
⁴ Department of Neurosurgery, Buffalo General Medical Center, Kaleida Health, Buffalo, NY, USA.
⁵ Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, 100 High Street, Suite B4, Buffalo, NY, 14203, USA. [email protected].
⁶ Department of Neurosurgery, Buffalo General Medical Center, Kaleida Health, Buffalo, NY, USA. [email protected].

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Abstract

During lateral lumbar fusion, the trajectory of implant insertion approaches the great vessels anteriorly and the segmental arteries posteriorly, which carries the risk of vascular complications. We aimed to analyze vascular injuries for potential differences between oblique lateral interbody fusion (OLIF) and lateral lumbar interbody fusion (LLIF) procedures at our institution. This was coupled with a systematic literature review of vascular complications associated with lateral lumbar fusions. A retrospective chart review was completed to identify consecutive patients who underwent lateral access fusions. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were used for the systematic review with the search terms “vascular injury” and “lateral lumbar surgery.” Of 260 procedures performed at our institution, 211 (81.2%) patients underwent an LLIF and 49 (18.8%) underwent an OLIF. There were no major vascular complications in either group in this comparative study, but there were four (1.5%) minor vascular injuries (2 LLIF, 0.95%; 2 OLIF, 4.1%). Patients who experienced vascular injury experienced a greater amount of blood loss than those who did not (227.5 ± 147.28 vs. 59.32 ± 68.30 ml) (p = 0.11). In our systematic review of 63 articles, major vascular injury occurred in 0-15.4% and minor vascular injury occurred in 0-6% of lateral lumbar fusions. The systematic review and comparative study demonstrate an increased rate of vascular injury in OLIF when compared to LLIF. However, vascular injuries in either procedure are rare, and this study aids previous literature to support the safety of both approaches.

Keywords:

Lateral lumbar interbody fusion (LLIF); Lateral lumbar spine surgery; Oblique lateral interbody fusion (OLIF); Vascular injury.

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