Anterior exposure of the spine for removal of lumbar interbody devices and implants

Study Design. A retrospective review of a consecutive series of 14 patients operated on between March 1998 and April 2005. Objectives. To report on patients having undergone revision lumbar surgery anteriorly to remove interbody devices placed anteriorly or posteriorly and to determine the incidence of associated complications. Summary of Background Data. The popularity of interbody lumbar surgery has grown in recent years. Consequently, the number of anterior revision procedures has increased. The risks associated with anterior approach for revision procedures and interbody device removal, in particular, have not been reported. Methods. The results of 13 consecutive patients who had removal of interbody devices through an anterior approach and 1 patient with removal of anterior fixation (7 males, 7 females; mean age 43 years) were reviewed. The procedure during which the original implant was placed was a posterior lumbar interbody fusion in 4, transforaminal lumbar interbody fusion in 5, and anterior lumbar interbody fusion in 5 patients. Four attending spine surgeons performed the procedures with the assistance of 4 experienced access surgeons. Results. Ten of 14 (71%) patients had complications associated with anterior exposure of revision surgery. Vascular injury is the most common complication (57%). Vascular complications occurred in 100% (4/4) of the revisions of previous posterior lumbar interbody fusions and 80% (4/5) of previous anterior lumbar interbody fusions. The complication rate at L4-5 and L5-S1 was 89% and 40%, respectively. There was 1 postoperative mortality. Conclusions. Anterior removal of lumbar interbody devices placed anteriorly or posteriorly has a high incidence of complication. Average blood loss and hospital stay are increased with revision anterior surgery. The vascular complication rate is 2-fold higher at L4-L5 level compared to L5-S1.