• Aécio Rubens Dias Pereira Filho, Vinicius Santos Baptista, Matheus Galvão Valadares Bertolini Mussalem, Francisco Cialdine Frota Carneiro Júnior, Vinicius de Meldau Benites, Alexandre Vinhal Desideri, Milton Kiyonory Uehara, Nuno Rodolfo Colaço Aguiar, and Arthur Cristiano Baston.
• Instituto de Acessos à coluna Aécio Dias, São Paulo, São Paulo, Brazil. Electronic address: cientifico.iaad@gmail.com.
• World Neurosurg. 2024 Apr 1; 184: 165174165-174.

ObjectiveWe assessed the frequency of intraoperative complication rates related to access surgery, operating time, and intraoperative bleeding rates described in the literature for patients undergoing anterior lumbar interbody fusion (ALIF) to evaluate the adverse effects and, thus, help in therapeutic decision making and contribute to future clinical trials.MethodsA systematic review was conducted of MEDLINE and Embase databases in March 2023. The main inclusion criteria were adult patients aged >18 years, with no maximum age limit; the use of ALIF; the presence of quantitative data on intraoperative complications; and randomized controlled trials and cohort studies. Vascular and peritoneal injuries were considered primary endpoints. The operative time and intraoperative bleeding rate were secondary endpoints. Reports and case series, case-control series, systematic reviews, and meta-analyses were excluded.ResultsEight studies were included with a total of 2395 patients. We found important quantitative data for future randomized clinical studies involving ALIF surgery, including the rate of vascular lesions (2.79%) and peritoneal lesions (0.37%). In addition to these factors, only 4 of the 8 studies addressed the average surgery time, with a total average of 145.61 minutes. Furthermore, 6 of the 8 articles reported the mean rate of intraoperative bleeding, with a total mean blood loss of 272.75 mL.ConclusionsALIF is a lumbar spine access technique with low intraoperative complications. Patients with contraindications have a higher risk of complications. Randomized clinical trials are needed to assess the efficacy and safety of the procedure.Copyright © 2024 Elsevier Inc. All rights reserved.

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