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The Open Retroperitoneal Approach for Spine Procedures: Experience with 59 Patients

Andrew A Gumbs
Yale-New Haven Hospital, NewHaven, CT

Objective:
With the advent of anterior lumbar interbody fusion as a common procedure for the treatment many spinal problems, exposure has become an increasingly popular procedure. Despite this the body of literature describing this procedure is lacking, especially in the General and Vascular Surgery Literature.
Design:
A retrospective review of charts was performed on patients operated on from April 2002 until January 2004.
Setting:
Tertiary Care University Hospital
Patients:
In total 59 open retroperitoneal exposures for anterior spinal approaches were perfomed. Thirty-two (54%) were performed on men and 27 (46%) on women. The average age was 43 (range=27-89).
Interventions:
Eighty percent (47) of patients required lumbo-sacral exposures through small right or left paramedian incisons, 12% (7) underwent mid-sacral approaches, which occasionally were perfomed via Pfannensteil incisons and 8% (5) required thoraco-abdominal retroperitoneal exposures. Sixty-three percent (37) of patients underwent ALIF, 34% (20) had a Prodisc®, an artificial disk replacement system.
Main Outcome Measures:
We analyzed intra-operative and early post-operative complications.
Results:
Ninety-seven percent of all attempted retroperitoneal exposures were successful. Intra-operative complications occurred in 5 patients (8%) of patients, and included inability to mobilize the iliac veins, injury to the iliac vein and ureteral tear. The post-operative course was complicated in eight (14%) patients, and included fever, urinary retention, spinal headache, c.difficile colitis and ileus.
Conclusion:
Open retroperitoneal exposure can be performed safely and we believe a multidisciplinary approach maximizes the various surgical skills of the Orthopedic and Vascular or General surgeon, reducing complication rates in anterior spinal surgery.

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