Standalone Anterior Lumbar Interbody Fusion Without Supplementary Posterior Fixation Is Effective for Treatment of Symptomatic Grade 1 Isthmic Spondylolisthesis.

Background: There is a paucity of data examining anterior lumbar interbody fusion (ALIF) with pedicle-screw fixation (ALIF-PSF) or without (standalone, sa-ALIF) for the treatment of low-grade isthmic spondylolisthesis (IS). Treating pathology with sa-ALIF reduces costs, operative times, and posterior access morbidity. This study aimed to investigate the clinical and radiographic outcomes of sa-ALIF for the management of low-grade IS compared with an ALIF-PSF cohort.

Who bleeds during elective anterior lumbar surgery?

Background: Blood loss (BL) during elective anterior lumbar access for interbody fusion or disc replacement is a potentially major complication. This study sought to identify factors other than major vascular injury which contribute to BL and therefore this risk. Factors suggested to effect blood loss include age, increasing body mass index (BMI), sex, prothesis, intraoperative heparinization and continuation of low-dose aspirin (LD-ASA).

Modic Changes on Magnetic Resonance Imaging and Smoking History Predict Vascular Adherence During Anterior Lumbar Exposure.

Background: Anterior approaches to surgically access the lumbar intervertebral discs are associated with a risk of developing major vascular injury and bleeding. The likelihood of injury increases in the presence of dense adherence between the disc annulus, vertebral periosteum, and vessels, which result from reactive inflammatory changes that cause fibrous scarring.

Objective: To identify factors that predict vascular adherence, which may facilitate preoperative planning and technique modifications for anterior spine surgery.

Surface landmarks for anterior lumbar access: is fluoroscopy necessary?

Background Context: Anterior lumbar fusion surgery is increasing by an estimated 24% annually in the United States. There is a paucity of precise anatomic guidelines to help surgeons determine the appropriate anterior access incision site.

Purpose: The purpose of this study is to compare the available anterior surface landmarks for the L4/L5 and L5/S1 disk levels to the disk levels determined by fluoroscopy, with the goal of creating a guide for surgical incision sites in anterior lumbar access surgery.

Anterior lumbar interbody fusion in a lateral decubitus position: technique and outcomes in obese patients.

Background: Multilevel lumbar interbody fusion (LIF) surgery in obese patients is problematic, with positioning and anaesthetic risks during posterior approaches, vascular and visceral complications during anterior approaches, and lack of access to L5/S1 during lateral approaches. Modified anterior LIF (ALIF) via an anterolateral retroperitoneal approach in the lateral decubitus position permits access to L3/4, L4/5, and L5/S1 levels without patient repositioning. This study reports our initial experience with this lateral ALIF in obese patients and describes modifications of existing lateral and anterior techniques.

How to do it: a modified transabdominal wall approach for direct external iliac artery access during endovascular thoracic aneurysm repair.

We describe the combined application of a transabdominal wall sheath tunnel, 'pre-close' purse-string sutures and manual external support of the iliac artery to facilitate introduction of an 18F sheath for endovascular exclusion of a 6-cm thoracic aortic aneurysm.

Brief intraoperative heparinization and blood loss in anterior lumbar spine surgery.

Object: The anterior approach to the lumbar spine may be associated with iliac artery thrombosis. Intraoperative heparin can be administered to prevent thrombosis; however, there is a concern that this will increase the procedural blood loss. The aim of this study was to examine whether intraoperative heparin can be administered without increasing blood loss in anterior lumbar spine surgery.

A case of abdominal trauma.

Multiple injuries resulting from the use of nail guns have been described in the literature; however, to date there has been no report of a nail gun injury to the abdomen. We describe the case of a 30-year-old male tradesperson who suffered a penetrating nail gun injury to the epigastrium, resulting in multiple injuries to the bowel and an inferior vena caval injury with massive haemorrhage. This case demonstrates the wide range of injuries capable of being inflicted by a single penetrating injury, and emphasizes the need for proper training and safety measures in the use of nail guns.

Anterior lumbar interbody fusion using recombinant human bone morphogenetic protein-2: a prospective study of complications.

Object: The use of recombinant human bone morphogenetic protein-2 (rhBMP-2) in anterior lumbar interbody fusion (ALIF) is controversial regarding the reported complication rates and cost. The authors aimed to assess the complication rates of performing ALIF using rhBMP-2.

Methods: This is a prospective study of consecutive patients who underwent ALIF performed by a single spine surgeon and a single vascular surgeon between 2009 and 2012.

Anterior pseudoarthrectomy for symptomatic Bertolotti's syndrome.

Painful L5/S1 pseudoarthrosis has been previously managed with posterior excision and/or lumbar fusion. To our knowledge, the anterior approach for L5/S1 pseudoarthrectomy in the treatment of Bertolotti's syndrome has not been described. We present two patients with severe symptomatic L5/S1 pseudoarthroses that were successfully excised via an anterior retroperitoneal approach with 2 year clinical and radiological follow-up.

Early postoperative dislocation of the anterior Maverick lumbar disc prosthesis: report of 2 cases.

The authors report on 2 cases of anterior dislocation of the Maverick lumbar disc prosthesis, both occurring in the early postoperative period. These cases developed after experience with more than 50 uneventful cases and were therefore thought to be unrelated to the surgeon's learning curve. No similar complications have been previously reported.