Vascular complications in anterior thoracolumbar spinal reconstruction

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Object. Anterior approaches in thoracic and lumbar spinal surgery have potentially serious vascular injury—related complications. In this study the authors evaluate the incidence of vascular complications in anterior approaches to the thoracic and lumbar spine in cases requiring reconstructive surgery.

Methods. The authors retrospectively reviewed the medical records of 207 patients who underwent anterior thoracic and lumbar spinal reconstructive surgery during the period from 1992 through 1999 to determine the incidence, causes, and management of vascular complications.

Overall, the incidence of vascular complications following reconstructive spinal surgery was 5.8% (12 patients) and the mortality rate was 1% (two patient deaths). In seven patients (3.4%), direct vascular injuries developed as a result of surgical techniques or error; one patient died as a result. Five patients (2.4%) developed deep venous thromboses, and one patient in this subgroup died of pulmonary embolism.

Conclusions. Vascular injury to the great vessels is a known and potentially serious complication associated with anterior spinal reconstructive procedures. The authors found, however, that the incidence is relatively low in cases in which venous injuries occurred acutely and arterial injuries presented in a delayed fashion.

Article Information

Address reprint requests to: J. Patrick Johnson, M.D., Institute of Spinal Disorders, Cedars-Sinai Medical Center, 444 San Vicente, Suite 800, Los Angeles, California 90048. email: johnsonjp@cshs.org.

© AANS, except where prohibited by US copyright law.

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    Sagittal T2-weighted magnetic resonance image of the thoracic spine revealing a solitary tumor mass at the level of T6–7. An isointense mass with moderate contrast enhancement and a homogeneous hypointense mass are shown.

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    Postoperative x-ray film demonstrating a titanium mesh cage filled with autologous iliac bone graft and T5–8 anterolateral plate system.

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    Chest CT scan revealing a hemothorax and dissection of the descending aorta with the true lumen measuring 3 cm in diameter. The crescentric false lumen (arrow) measures 1 cm in thickness posterolaterally.

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