The vascular surgeon and minimally invasive surgery of the lumbar spine

Introduction: The advances in lumbar spinal surgery over the last few years have led to new approaches to anterior and anterior-lateral surfaces of the lumbar spine. As the exposure of disc space requires dissection and mobilization of iliac vessels, vascular surgeons often use this approach. Objective: To describe general and vascular complications, which occurred over a nine-year period, using the anterior retroperitoneal approach for the implantation of a total lumbar disc replacement, with a small abdominal skin incision. Material and methods: Retrospective study of patients operated on between 2000-2009 (72 patients). The technical steps of the anterior retroperitoneal approach in lumbar spinal surgery with laparoscopic assistance and a minimal incision (L5-51 and L4-L5) are described, as well as general and vascular complications. Results: Ther following complications were recorded: one lymphocele; one dehiscence of the rectus sheath; one patient with retrograde ejaculation; one hemorrhage as a result of a wrong ligature of the cincumflex iliac vein performing a direct suture; one hemorrhage requiring two units of packed red cells; and a lesion in the left common iliac vein needing a direct suture. Conclusion: Lumbar spinal surgery for the implantation of a total lumbar disc replacement from an anterior retroperitoneal approach and with laparoscopic assistance is a safe and minimally invasive procedure. In our series vascular complications have been very unusual; in our opinion, due to a multidisciplinary team consisting of a vascular surgeon and a lumbar spine surgeon, both of whom have experience in endoscopic-laparoscopic surgery operating on these patients. (C) 2010 SEACV. Published by Elsevier Espana, S.L. All rights reserved.