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.

Effect of prone positioning systems on hemodynamic and cardiac function during lumbar spine surgery: an echocardiographic study.

STUDY DESIGN: Prospective randomized study of patients undergoing spine surgery. OBJECTIVE: To compare changes in hemodynamic and cardiac function after prone positioning using different prone positioners. SUMMARY OF BACKGROUND DATA: Prone positioning decreases blood pressure and cardiac function. Several studies have evaluated changes in cardiac function after prone positioning, and linked them to reduced venous return and ventricular compliance. This study compares different prone positioners using transesophageal echocardiography, and determines their effect on cardiac function and hemodynamics. METHODS: After correction of fluid deficits with the patient under stable anesthesia, hemodynamic and cardiac performance was measured using transesophageal echocardiography. After prone positioning, repeat measurements were performed, and comparisons were made between prone and supine positions. RESULTS: No intergroup differences in demographics, fluid deficit, baseline hemodynamics, or differences from supine to prone position were noted. Cardiac output decreased with the Wilson (Union City, CA) and Siemens AG (Munich, Germany) frames, while cardiac index and stroke volume decreased with the Andrews (Hollywood, CA), Wilson, and Siemens systems. Cardiac preload decreased using the Andrews frame. The Jackson spine table (Hollywood, CA) and bolsters had the least effect on cardiac performance. CONCLUSION: Adequate fluid replacement reduced hypotension and hemodynamic instability after prone positioning. The Jackson spine table and longitudinal bolsters had minimal effects on cardiac function, and should be considered in patients with limited cardiac reserve.