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World J Orthop. Jan 18, 2013; 4(1): 19-23
Published online Jan 18, 2013. doi: 10.5312/wjo.v4.i1.19
Access related complications during anterior exposure of the lumbar spine
Gary A Fantini, Abhijit Y Pawar
Gary A Fantini, Abhijit Y Pawar, Spinal Surgical Service, Department of Orthopaedic Surgery, Hospital for Special Surgery and Weill Cornell Medical College, New York, NY 10021, United States
Author contributions: Both authors contributed to conception and design of review material, drafting and/or critically revising the article, and final approval of the version to be published.
Correspondence to: Gary A Fantini, MD, Spinal Surgical Service, Department of Orthopaedic Surgery, Hospital for Special Surgery and Weill Cornell Medical College, New York, NY 10021,United States. gaf@newyorkphysicians.com
Telephone: +1-212-3174550 Fax: +1-212-7522454
Received: April 20, 2012
Revised: December 18, 2012
Accepted: December 23, 2012
Published online: January 18, 2013
Abstract

The new millennium has witnessed the emergence of minimally invasive, non-posterior based surgery of the lumbar spine, in particular via lateral based methodologies to discectomy and fusion. In contrast, and perhaps for a variety of reasons, anterior motion preservation (non-fusion) technologies are playing a comparatively lesser, though incompletely defined, role at present. Lateral based motion preservation technologies await definition of their eventual role in the armamentarium of minimally invasive surgical therapies of the lumbar spine. While injury to the major vascular structures remains the most serious and feared complication of the anterior approach, this occurrence has been nearly eliminated by the use of lateral based approaches for discectomy and fusion cephalad to L5-S1. Whether anterior or lateral based, non-posterior approaches to the lumbar spine share certain access related pitfalls and complications, including damage to the urologic and neurologic structures, as well as gastrointestinal and abdominal wall issues. This review will focus on the recognition, management and prevention of these anterior and lateral access related complications.

Keywords: Anterior spinal exposure; Lumbar spine; Complications