Comparison Of Vascular Surgical Outcomes Between Anterior Lumbar Interbody Fusion And Oblique Lumbar Interbody Fusion

Introduction: Chronic low back pain is the second leading cause of disability worldwide. Lumbar degenerative spine disease is a significant cause of LBP and encompasses spondylolisthesis, lumbar spinal stenosis, and disc degeneration. Multiple surgical treatment options exist. There have been numerous studies investigating general complications between these approaches but none with a vascular focus and depth. The aim of this study is to investigate vascular injuries between the ALIF and OLIF approaches.

Methods: All full-text English-language manuscripts studying the vascular complications between anterior lumbar interbody fusion and oblique lumbar interbody fusion approach were screened using PubMed and Embase.

Results: 112 articles were identified, of which 68 were included. Two studies were prospective series, and the remaining 110 were retrospective. All included studies totaled 13,517 patients with a total follow-up of 30.23 months, ranging from 8 to 209 months. In the surgical treatment of lumbosacral disc pathology, vascular complications averaged 3.2% (95% CI 0.022-0.042) and 1.3% (95% CI 0.006-0.019) in ALIF and OLIF approaches, respectively (p < 0.05). Estimated blood loss per case averaged 144.51 mL (95% CI 103.012-186.015) vs. 133.578 mL (95% CI 111.326-155.829) in ALIF and OLIF approaches, respectively.

ALIF studies reported a total of 262 vascular injuries, with the most common being the left common iliac vein (72%, 190/262), left common iliac artery (9.9%, 26/262), and the inferior vena cava (4.9%, 12/262). OLIF studies reported a total of 36 vascular injuries, with the most common being the left segmental artery (36%, 13/36), left common iliac vein (25%, 9/36), and left iliolumbar vein (19%, 7/36).

Conclusion : The ALIF approach was associated with a higher rate of vascular injuries than the OLIF approach. In 72% of the cases, the most common injured vessel was the left common iliac vein, followed by the left common iliac artery (9.9%).