Surgical complications of the anterior approach to the L5/S1 intervertebral disc

Lumir Hrabalek,Milan Adamus,Peter Tucek,Tomas Wanek,Josef Machac

doi:10.5507/bp.2011.064

Abstract

The aims of this study were to describe the incidence and type of perioperative complications that occur with minimally invasive anterior retroperitoneal spinal surgery performed at the level of the L5/S1 intervertebral disc. A retrospective review of 175 patients: 103 women and 72 men, average age 45, who had undergone anterior spinal surgery at level L5/S1 from January 2001 to February 2011. The preoperative diagnoses were: degenerative disc disease in 87 (50%), failed back surgery syndrome in 53 (30%) and spondylolisthesis in 35 patients (20%). The surgical steps in the minimally invasive anterior retroperitoneal approach from the right side to disc L5/S1 are described. All surgical intraoperative anatomical anomalies and complications directly related to the anterior spinal surgery were documented. Intraoperative pathological-anatomical anomalies were found in 34 patients (19%) and intra - and postoperative minor complications in 24 patients (12%) but no serious complications. The main intraoperative complication was peritoneal opening without visceral injury (5%) and the main postoperative complication was weakness of the right abdominal wall (3%). . Retroperitoneal access and surgery at level L5/S1 disc space is a safe procedure when performed by a knowledgeable and experienced spine team. During surgical planning for an anterior approach to the LS spine, the surgeon must carefully assess the neuroimaging results, such as MRI, to minimize potentially disastrous vascular complications.

Highlights

Despite increased use of anterior spinal surgery, there is little documentation of the specific types and frequencies of complications associated with its use
The aims of this study were to report prospectively the incidence and specific types of perioperative complications that occur with minimally invasive anterior retroperitoneal spinal surgery performed at level of the L5/S1 intervertebral disc
We reviewed all cases of anterior surgery at level L5/ S1, treated at the Department of Neurosurgery from January 2001 to February 2011

Summary

Introduction

Despite increased use of anterior spinal surgery, there is little documentation of the specific types and frequencies of complications associated with its use. Review of the spinal surgery literature revealed a dearth of studies that address the morbidity and mortality rates in large samples of patients who had undergone anterior surgery at level L5/S1. The aims of this study were to report prospectively the incidence and specific types of perioperative complications that occur with minimally invasive anterior retroperitoneal spinal surgery performed at level of the L5/S1 intervertebral disc. (FBSS) in 53 (30%) and spondylolisthesis in 35 patients (20%). They suffered from low back pain (LBP) and radiculopathy itself and conservative treatment was not effective for a minimum of 6 months. Sixty four (37%) patients had undergone one or more prior abdominal surgeries including appendectomy in 30 (17% of 175 patients), cesarean section in 39 (38% of 103 female); and cholecystectomy, gastric surgery, inguinal hernia in 2 each and umbilical hernia in 1

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