Intraoperative Venous Injury During Anterior Lumbar Interbody Fusion: Incidence, Risk Factors, and Complications

Area of Science:

• Spine surgery
• Vascular injury
• Epidemiology

Background:

• Anterior lumbar interbody fusion (ALIF) is a common spinal procedure.
• Intraoperative venous injuries are a potential complication during ALIF.
• Understanding risk factors and outcomes is crucial for patient safety.

Purpose of the Study:

• To determine the incidence of intraoperative venous injury during ALIF.
• To identify independent risk factors associated with venous lacerations.
• To evaluate the complications linked to these injuries, including deep vein thrombosis (DVT).

Main Methods:

• Retrospective cohort study of patients undergoing ALIF.
• Exclusion of patients under 18 or with trauma, infection, or malignancy.
• Statistical analyses including logistic regression to identify risk factors and complications.

Main Results:

• Venous laceration occurred in 16.61% of 554 patients.
• Independent risk factors: older age, chronic kidney disease, L4-5 and two-level ALIF.
• Protective factor: L5-S1 ALIF.
• Injuries associated with longer operative time, increased blood loss, and higher risk of DVT, transfusion, and wound complications.

Conclusions:

• Venous laceration is a significant complication in ALIF, affecting 16.61% of patients.
• Age, CKD, and specific ALIF levels/multiplicity are key risk factors.
• Venous injuries increase operative time, blood loss, and DVT risk, necessitating targeted prevention strategies and VTE prophylaxis.