Vascular injuries during anterior exposure of the thoracolumbar spine.

BACKGROUND: The aim of this study was to evaluate the vascular injuries, repairs, and complications encountered during anterior thoracolumbar spine exposures. METHODS: The medical records of patients undergoing anterior spine exposures from January 2004 to June 2010 were retrospectively analyzed. RESULTS: A total of 269 anterior exposures were performed in 260 patients. The average patient age was 50.1 years, and the average body mass index was 29.0. Female patients represented 146 (54.3%) cases. Previous spinal surgery was noted in 145 (53.9%) cases, and 19 (7.1%) had previous anterior exposure. The median estimated blood loss (EBL) was 300 mL, and there were no postoperative mortalities. A vascular injury occurred in 37 cases (13.8%), with redo anterior exposure (n = 19, 52% vs. 11%; P < 0.001), previous spinal surgery (n = 145, 19% vs. 7%; P = 0.01), and diagnosis of a tumor (n = 14, 36% vs. 12.5%; P = 0.03) being associated with increased vascular injury. A vascular injury resulted in greater EBL (median: 800 mL vs. 300 mL; P < 0.001) and longer hospitalization (median: 7 days vs. 5 days; P = 0.04). Most frequently injured was the left common iliac vein (in 21 of the 37 [52.5%] injured cases). A vascular surgeon performed the exposure in 159 (59.1%) cases. There was a decrease in EBL (250 mL vs. 500 mL; P < 0.001), total incision time (290 minutes vs. 404 minutes; P = 0.002), and length of stay (5 days vs. 6.5 days; P < 0.001) as compared with the operations where the vascular surgeon was not involved in the exposure. These cases also had an increased incidence of any vascular injury (28 vs. 9; P = 0.04). There were no differences between groups regarding vascular injury type, repair type, or the incidence of deep venous thrombosis. CONCLUSION: Collaboration between spine and vascular teams may result in decreased blood loss and consequently improved morbidity and length of hospital stay.

Alternative management of iliac vein injury during anterior lumbar spine exposure.

Vascular injuries are, unfortunately, common complications during anterior approach to lumbar spine, with venous injuries occurring most frequently. The L4-L5 level of exposure is associated most commonly with venous injuries because it requires significant mobilization of the vascular structures. We present two cases of left common iliac vein tears encountered during redo anterior exposure for spine revision. This was in the setting of an anterior lumbar interbody fusion at the L4-L5 level and for the repeat disc arthroplasty at the L5-S1 level. We describe the endovascular technique used to successfully repair venous tear with the deployment of a covered stent across the injury, preventing the ligation of the left common iliac vein.