Introduction:

One of the main concerns of anterior lumbar spine approaches are vascular complications. The aim of our study is to provide technical details about a flap technique using the anterior longitudinal ligament (ALL) when approaching the lumbar spine via an anterior corridor. This can help decrease complications by protecting the adjacent vascular structures. We also include a retrospective cohort review.

Materials and methods:

This is a retrospective bi-centric study: 189 patients with a mean age of 44.2 y underwent anterior lumbar spine surgery using the ALL flap technique. Patients were diagnosed with degenerative pathologies. 239 lumbar levels were treated primarily at the L4-5 and L5-S1: 88 single level Anterior Lumbar Interbody Fusion (ALIF), 9 two levels ALIF, 51 total disc replacement (TDR) and 41 hybrid constructs (i.e. ALIF L5S1 and TDR L4L5).Anterior approaches were performed by two senior spine surgeons. The ALL flap technique was utilized in all of these cases, by carefully dissecting the ALL, with the flap suspended using sutures. As such, this ALL flap provided a “safe corridor” to avoid any potential vascular laceration.

Results:

Operative and early surgical complication rate was 3.2%. There was no arterial injury. There were only 2 minor venous laceration (1.05%). No blood transfusion was required. Neither lacerations happened during disc space preparation.

Conclusion:

Here, we provide technical details about a simple and reproducible technique using the ALL as a flap which may help spine surgeons minimize vascular injuries during ALIF or even TDR surgeries.