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An Update in Complication Rates Associated With Anterior Lumbar Surgery: A Systematic Review and Meta-Analysis.

Tariq Z Issa1, Teeto Ezeonu2, Mason Sellig2

  • 1Department of Orthopaedic Surgery, Icahn School of Medicine, The Mount Sinai Hospital, New York, NY, USA.

Global Spine Journal
|August 28, 2024
PubMed
Summary

Anterior lumbar surgery has a 13.1% complication rate. Mini-open techniques may reduce reoperations, while computed tomography angiography (CTA) increases complications. Access surgeons decrease reoperation risk.

Keywords:
anterior lumbar interbody fusionanterior lumbar surgeryapproach surgeoncomplicationsspinesystematic reviewvascular injury

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Area of Science:

  • Spinal surgery
  • Orthopedics
  • Neurosurgery

Background:

  • Anterior lumbar fusion techniques are widely used.
  • Understanding associated complications is crucial for patient safety.
  • Adjuvant resources like computed tomography angiography (CTA), bone morphogenetic protein-2 (rhBMP-2), and access surgeons may influence outcomes.

Purpose of the Study:

  • To perform an updated systematic review and meta-analysis.
  • To evaluate complications of anterior lumbar fusion techniques and approaches.
  • To assess the impact of CTA, rhBMP-2, and access surgeons on complication rates.

Main Methods:

  • Systematic review of studies from 1/1/2014 to 4/1/2024.
  • Inclusion of 54 studies with 8066 patients.
  • Meta-analysis using a generalized linear mixed model to compare complication rates.

Main Results:

  • Overall complication rate was 13.1% (intraoperative 3.8%, postoperative 7.4%, infection 1.5%, reoperation 1.7%).
  • No significant difference in overall complications between open and mini-open techniques, but mini-open had lower reoperation rates.
  • Computed tomography angiography (CTA) use increased complications; access surgeons decreased reoperation risk; rhBMP-2 showed no association with overall complications.

Conclusions:

  • Anterior lumbar surgery has a known complication profile.
  • Surgeons and patients must consider safety and complication risks.
  • Further high-quality research is needed to clarify the benefits of specific techniques and adjuvant resources in mitigating complications.