PDF(Pubmed)
Abstract：
BACKGROUND: Anterior lumbar interbody fusion (ALIF) can treat spondylolisthesis, degenerative disc disease and pseudoarthrosis. This approach facilitates complete discectomy, disc space distraction, indirect decompression of neural foramina and placement of large interbody devices. Several intra- and postoperative complications can be attributed to the anterior approach: vascular/visceral injury, hypogastric plexus injury and urogenital consequences. Spine-specific complications include implant migration, graft failure, pseudoarthrosis and persistent symptomology.
METHODS: This retrospective study reviewed patient demographics, medium-term outcomes and complication rates following ALIF surgery performed over a 5-year period. A total of 110 consecutive patients had undergone ALIF surgery at a single tertiary spinal centre. The database was reviewed with a primary outcome of identifying postoperative 90-day complications and whether a revision anterior operation was required after primary ALIF.
RESULTS: No patients required revision anterior operation after their primary ALIF surgery by final follow-up. Out of 110 patients, 11 (10%) recorded a complication attributed to the anterior stage of their operation within 90 days.
CONCLUSIONS: Our 90-day complication rate of 10% lies within the 2.6% acute complication and 40% overall complications rates described in previous literature. The risk of vascular/visceral injury is significant (3%) and we recommend that ALIF be performed as a dual surgeon procedure with a vascular-trained access surgeon accompanying the spinal surgeon. ALIF is a valid revision surgical option for failed posterior approaches leading to complications such as pseudoarthrosis. In our sample, 89% of patients were managed with posterior fixation to augment the anterior fusion as, biomechanically, this is a proven construct.
METHODS: This retrospective study reviewed patient demographics, medium-term outcomes and complication rates following ALIF surgery performed over a 5-year period. A total of 110 consecutive patients had undergone ALIF surgery at a single tertiary spinal centre. The database was reviewed with a primary outcome of identifying postoperative 90-day complications and whether a revision anterior operation was required after primary ALIF.
RESULTS: No patients required revision anterior operation after their primary ALIF surgery by final follow-up. Out of 110 patients, 11 (10%) recorded a complication attributed to the anterior stage of their operation within 90 days.
CONCLUSIONS: Our 90-day complication rate of 10% lies within the 2.6% acute complication and 40% overall complications rates described in previous literature. The risk of vascular/visceral injury is significant (3%) and we recommend that ALIF be performed as a dual surgeon procedure with a vascular-trained access surgeon accompanying the spinal surgeon. ALIF is a valid revision surgical option for failed posterior approaches leading to complications such as pseudoarthrosis. In our sample, 89% of patients were managed with posterior fixation to augment the anterior fusion as, biomechanically, this is a proven construct.
摘要：
背景：腰椎前路椎间融合术（ALIF）可以治疗腰椎滑脱，退行性椎间盘疾病和假关节病。这种方法有助于完全椎间盘切除术，椎间盘空间分散，神经孔的间接减压和大型椎间装置的放置。几种术中和术后并发症可归因于前路：血管/内脏损伤，胃下神经丛损伤和泌尿生殖系统的后果。脊柱特异性并发症包括植入物迁移，移植失败，假性关节炎和持续性症状学。
方法：这项回顾性研究回顾了患者的人口统计学，ALIF手术5年后的中期结局和并发症发生率.共有110名连续患者在一个三级脊柱中心接受了ALIF手术。对数据库进行了审查，主要结果是确定术后90天的并发症以及原发性ALIF后是否需要进行前路翻修手术。
结果：最终随访时，没有患者在进行ALIF初次手术后需要进行前路翻修。110名患者中,11（10％）记录了90天内手术前阶段的并发症。
结论：我们的90天并发症发生率为10%，在先前文献中描述的2.6%的急性并发症和40%的总体并发症发生率之内。血管/内脏损伤的风险很大（3％），我们建议ALIF作为双重外科医生进行，并由受过血管训练的外科医师陪同脊柱外科医生。ALIF是一种有效的翻修手术选择，可用于失败的后路手术，从而导致假关节病等并发症。在我们的样本中，89%的患者接受了后路固定以加强前路融合，生物力学，这是一个成熟的结构。
方法：这项回顾性研究回顾了患者的人口统计学，ALIF手术5年后的中期结局和并发症发生率.共有110名连续患者在一个三级脊柱中心接受了ALIF手术。对数据库进行了审查，主要结果是确定术后90天的并发症以及原发性ALIF后是否需要进行前路翻修手术。
结果：最终随访时，没有患者在进行ALIF初次手术后需要进行前路翻修。110名患者中,11（10％）记录了90天内手术前阶段的并发症。
结论：我们的90天并发症发生率为10%，在先前文献中描述的2.6%的急性并发症和40%的总体并发症发生率之内。血管/内脏损伤的风险很大（3％），我们建议ALIF作为双重外科医生进行，并由受过血管训练的外科医师陪同脊柱外科医生。ALIF是一种有效的翻修手术选择，可用于失败的后路手术，从而导致假关节病等并发症。在我们的样本中，89%的患者接受了后路固定以加强前路融合，生物力学，这是一个成熟的结构。
