Infraumbilical anterior retroperitoneal exposure of the lumbar spine in 128 consecutive patients

Background: Anterior spinal fusion can be approached through a retroperitoneal exposure lessening the risks of intra-abdominal exploration. The aim of this study is to report the complication rate and risk factors associated with anterior spinal fusion. Methods: A retrospective review and analysis of 128 consecutive patients undergoing anterior lumbar fusion was performed looking to correlate potential risk factors with known serious complications of this operation such as vein injury, deep vein thrombosis, pulmonary embolism, and death. Results: The overall complication rate was 15.5%, with 7.75% being considered serious complications. The most common complication was vein injury (5.4%), but no blood transfusions were required. Postoperatively, there was one death (0.8%), one pulmonary embolism, and one intraoperative hypoxic episode of undetermined etiology. Univariate analysis showed that vein injury was associated with increased operative time (p < .001) and associated with increased blood loss (p = .02) but not increased length of stay (p = .13). By multivariate analysis, operative time and length of stay were influenced by the approach of the operation (anterior alone versus anterior and posterior fixation), but not by the presence of vein injury or blood loss. Conclusions: In this large series of patients undergoing anterior spinal fusion by a dedicated surgical team, there was a single death, and although vein injury was the most frequent serious complication, it did not lead to an increase in operative time or length of stay.