Vascular complications in anterior thoracolumbar spinal reconstruction

Object. Anterior approaches in thoracic and lumbar spinal surgery have potentially serious vascular injury-related complications. In this study the authors evaluate the incidence of vascular complications in anterior approaches to the thoracic and lumbar spine in cases requiring reconstructive surgery. Methods. The authors retrospectively reviewed the medical records of 207 patients who underwent anterior thoracic and lumbar spinal reconstructive surgery during the period from 1992 through 1999 to determine the incidence, causes, and management of vascular complications. Overall, the incidence of vascular complications following reconstructive spinal surgery was 5.8% (12 patients) and the mortality rate was 1% (two patient deaths). In seven patients (3.4%), direct vascular injuries developed as a result of surgical techniques or error; one patient died as a result. Five patients (2.4%) developed deep venous thromboses, and one patient in this subgroup died of pulmonary embolism. Conclusions. Vascular injury to the great vessels is a known and potentially serious complication associated with anterior spinal reconstructive procedures. The authors found, however, that the incidence is relatively low in cases in which venous injuries occurred acutely and arterial injuries presented in a delayed fashion.