Abstract
Background context
The anterior approach to the lumbar spine is increasingly used to accomplish various
surgical procedures. However, the incidence and risk factors for complications associated
with anterior lumbar spine surgery (ALS) have not been fully elucidated.
Purpose
To identify and document types of complications and complication rates associated
with ALS, determine risk factors for these events, and evaluate the effect of measures
used to decrease complication rates.
Study design
Systematic review and meta-analysis.
Methods
A systematic review of the English-language literature was conducted for articles
published between January 1992 and December 2013. A MEDLINE search was conducted to
identify articles reporting complications associated with ALS. For each complication,
the data were combined using a generalized linear mixed model with a binomial probability
distribution and a random effect based on the study. Predictors used were the type
of procedure (open, minimally invasive, or laparoscopic), the approach used (transperitoneal
vs. retroperitoneal), use of recombinant bone morphogenetic protein-2, use of preoperative
computed tomography angiography (CTA), and the utilization of an access surgeon. Open
surgery was used as a reference category.
Results
Seventy-six articles met final inclusion criteria and reported complication rates
in 11,410 patients who underwent arthrodesis and/or arthroplasty via laparoscopic,
mini-open, and open techniques. The overall complication rate was 14.1%, with intraoperative
and postoperative complication rates of 9.1% and 5.2%, respectively. Only 3% of patients
required reoperation or revision procedures. The most common complications reported
were venous injury (3.2%), retrograde ejaculation (2.7%), neurologic injury (2%),
prosthesis related (2%), postoperative ileus (1.4%), superficial infection (1%), and
others (1.3%). Laparoscopic and transperitoneal procedures were associated with higher
complication rates, whereas lower complication rates were observed in patients receiving
mini-open techniques. Our analysis indicated that the use of recombinant bone morphogenetic
protein-2 was associated with increased rates of retrograde ejaculation; however,
there may be limitations in interpreting these data. Data regarding the use of preoperative
CTA and an access surgeon were limited and demonstrated mixed benefit.
Conclusions
Overall complication rates with ALS are relatively low, with the most common complications
occurring at a rate of 1% to 3%. Complication rates are related to surgical technique,
approach, and implant characteristics. Further randomized controlled trials are needed
to validate the use of preventative measures including CTA and the use of an access
surgeon.
Keywords
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Article info
Publication history
Published online: February 26, 2015
Accepted:
February 18,
2015
Received in revised form:
December 22,
2014
Received:
May 26,
2014
Footnotes
FDA device/drug status: Not applicable.
Author disclosures: DKB: Nothing to disclose. PWM: Stock Ownership: Globus Medical ($0). NS: Nothing to disclose. ABK: Nothing to disclose. MGM: Nothing to disclose. JDK: Nothing to disclose. ARV: Royalties: DePuy (C), Medtronic (H), Stryker Spine (G), Biomet Spine (C), Globus Medical (F), NuVasive (B), Aesculap (B); Stock Ownership: Replication Medica (15,000 shares, value B), Globus Medical (123,398 shares, value I), K-2 Medical, Paradigm Spine (975,000 shares, value F), Stout Medical (1% company, value E), Spine Medica (25,000 stock options, unknown value), Computational Biodynamics (50% ownership, unknown value), Progressive Spinal Technologies (30% ownership, unknown value), Spinology (8,125 shares, unknown value), Small Bone Innovations (15,000 shares, unknown value), Cross Current (62,500 shares, paid 50,000), Syndicom 2,750 shares, value 5,032), In Vivo (123,935 shares, unknown value), Flagship Surgical (Invested 50,000, value D), Advanced Spinal Intellectual Properties (30% ownership, unknown value), Cytonics (25,000 shares, unknown value), Bonovo Orthopedics (100,000 shares, paid 116,500), Electrocore (50,000 shares, unknown value), Gamma Spine (15% ownership, unknown value), Location Based Intelligence (20% ownership, unknown value), Flow Pharma (2,000,000 nonqualified stock options, unknown value), R.S.I (50% ownership, unknown value), Rothman Institute and Related Properties (practice, unknown value), Innovative Surgical (30% ownership, unknown value), Design (Unknown), Spinicity (53,000 shared, 3.4% ownership); Consulting: Gerson Lehrman Group (B), Guidepoint Global (B), Medacorp (B), Stout Medical (B), Innovative Surgical Design (B), Orthobullets (A); Board of Directors: AO Spine, Innovative Surgical Design, Association of Collaborative Spine Research, Spinicity; Grants: Stryker Spine, Cerapedics, NuVasive (C).
The disclosure key can be found on the Table of Contents and at www.TheSpineJournalOnline.com.
Disclosures: This work had no outside funding, and the authors present no conflicts of interest in relation to this study.
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