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

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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.

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Data availability

The results of this study are available upon request.

Code availability

Not applicable.

Abbreviations

ASA:

American Society of Anesthesiology

BMI:

Body mass index

CCI:

Charlson Comorbidity Index

DLIF:

Direct lateral interbody fusion

EMG:

Electromyography

LLIF:

Lateral lumbar interbody fusion

min:

Minutes

ml:

Milliliters

OLIF:

Oblique lateral interbody fusion

PRISMA:

Preferred Reporting Items for Systematic reviews and Meta-Analysis

STROBE:

Strengthening the Reporting of Observational Studies in Epidemiology

XLIF:

Extreme lateral interbody fusion

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Acknowledgements

We thank Ryley Herren for preparing the anatomical illustration and Debra J. Zimmer for editorial support.

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Authors and Affiliations

  1. Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo, NY, USA

    Alexander O. Aguirre & Shady Azmy

  2. Department of Neurosurgery, Faculty of Medicine, Cairo University, Cairo, Egypt

    Mohamed A. R. Soliman

  3. Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, 100 High Street, Suite B4, Buffalo, NY, 14203, USA

    Mohamed A. R. Soliman, Asham Khan, Patrick K. Jowdy, Jeffrey P. Mullin & John Pollina

  4. Department of Neurosurgery, Buffalo General Medical Center, Kaleida Health, Buffalo, NY, USA

    Mohamed A. R. Soliman, Asham Khan, Patrick K. Jowdy, Jeffrey P. Mullin & John Pollina

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  1. Alexander O. Aguirre
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  3. Shady Azmy
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  4. Asham Khan
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  5. Patrick K. Jowdy
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  6. Jeffrey P. Mullin
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  7. John Pollina
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Contributions

Conception and design: Pollina, Aguirre, Soliman.

Acquisition of data: Aguirre, Azmy

Interpretation of data: all authors

Drafting the manuscript: Aguirre, Soliman

Critically revising the manuscript: all Authors

Reviewed submitted version of manuscript: all Authors

Statistical analysis: Aguirre

Study supervision: Pollina

Corresponding author

Correspondence to John Pollina.

Ethics declarations

Ethics approval

University at Buffalo Institutional Review Board STUDY00005744.

Consent to participate

Consent was obtained from patients or a legally authorized representative before procedures were performed.

Consent for publication

At the time of hospital admission, informed consent for patient information to be published was provided by each patient or a legally authorized representative.

Conflict of interest

Dr. Khan received a research grant from the Scoliosis Research Society to study scoliosis in Chiari patients. Dr. Mullin receives research funding from AOSpine North America (AOSNA) and the Research Committee Award #87639; and from Medtronic External Research Program Health Professionals, ERP ID#2020–12271. Dr. Pollina is involved with surgical training for Medtronic, and he serves as a consultant for and receives royalties from ATEC Spine. All other authors have no personal, financial, or institutional interest in the materials or devices described in this manuscript.

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Aguirre, A.O., Soliman, M.A.R., Azmy, S. et al. Incidence of major and minor vascular injuries during lateral access lumbar interbody fusion procedures: a retrospective comparative study and systematic literature review. Neurosurg Rev 45, 1275–1289 (2022). https://doi.org/10.1007/s10143-021-01699-8

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