• Ardalan Alen Nourian, Christine Cunningham, Ali Bagheri, James D Bruffey, and Robert K Eastlack.
• *Division of Orthopaedics, Scripps Clinic, 10666 N Torrey Pines Rd, La Jolla, CA, 92037 †Shiley Center for Orthopedic Research and Education/Scripps Health, 11025 N Torrey Pines Rd, suite 200, La Jolla, CA, 92037 ‡San Diego Center for Spinal Disorders, 10666 N Torrey Pines Rd, La Jolla, CA, 92037.
• Spine. 2015 Sep 1.

Study DesignRetrospective review of prospectively collected data.ObjectiveThe study aim was to determine the prevalence of vascular complications associated with anterior lumbar interbody fusion (ALIF) as a function of anatomic variation and the number of levels fused.Summary Of Background DataALIF often require mobilization of the great vessels, particularly when exposing levels above L5-S1. The exposure can be more challenging in the setting of spondylolisthesis or transitional anatomy.MethodsThis retrospective review of prospectively collected data from our spine database identified 204 patients who had undergone single level (n = 62) or multilevel (n = 142) ALIF from 2008 to 2013 with minimum 6-month follow-up. Average age was 58 years; 57% were female. Preoperative radiographic assessment for spondylolisthesis and transitional anatomy was performed. Body mass index, estimated blood loss, and levels of ALIF were recorded. Intraoperative vascular injury, postoperative deep venous thrombosis and pulmonary embolism events were noted.ResultsEleven patients experienced postoperative thromboembolic events and were more likely to have had intraoperative vascular injury compared with patients who did not develop a vascular complication (36% and 5% respectively; p = 0.004). Estimated blood loss was significantly higher in patients with spondylolisthesis when compared to patients without spondylolisthesis (520cc vs. 103cc, respectively; p = 0.017) or transitional anatomy (347cc vs. 262cc, respectively; p = 0.022). Patients undergoing multilevel ALIF had significantly higher blood loss than patients undergoing a single level procedure (684cc vs. 107cc; p < 0.001). Patient characteristics, blood loss, anatomic variation, and level of approach were not associated with development of postoperative thromboembolic complications.ConclusionsPerforming ALIF in the setting of spondylolisthesis or transitional anatomy resulted in higher blood loss. Patients undergoing multilevel rather than single level ALIF experienced greater blood loss. Because patients with intraoperative vascular injury had increased likelihood of postoperative thromboembolic event, thrombosis prophylaxis should be considered in these patients.Level Of Evidence4.

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