Arterial complications following anterior lumbar interbody fusion: report of eight cases

The objective of this study is to report eight cases of arterial complication following anterior lumbar interbody fusion (ALIF) and to analyze the data in order to identify possible risk factors. The authors have encountered six cases of common iliac artery occlusion and two cases of acute vasospasm as a complication of ALIF using two different approaches to spine: hypogastricmidline-transperitoneal approach at one center and minimally invasive muscle-sparing retroperitoneal approach at the other. All cases involved surgery at the L4-L5 level. All patients were smokers, and three had an existing history of vascular disease. The left iliac and common femoral arteries were involved in seven cases, while the right common iliac was involved in one case. Five patients had thromboembolism, one patient had an intimal tear and two had functional vasospasm. Circulation to the lower limb was restored by thrombectomy (five patients) and arterioplasty for the intimal tear (one patient). One of the vasospasm cases was explored (false-positive), while the other was treated conservatively. One of the patients with thrombosis developed rhabdomyolysis resulting in fatal acidosis. All but the first case at each center was diagnosed either intraoperatively or within 2 h of surgery. We believe that awareness of this potentially serious complication will lead to precautionary measures for prevention of the problem as well as early diagnosis and management of the complication if it does occur. Intraoperative monitoring of lower limb blood flow by measuring the toe oxygenation with a pulse oxymeter can prove to be helpful in early diagnosis.