The Role of the Vascular Surgeon in Spinal Surgery

• Published in: Japanese Journal of Vascular Surgery Vol. 33; no. 3; pp. 115 - 119
• Main Authors: Saitoh, Yuhei, Ito, Kenyu, Tsushima, Mikito, Itatani, Keiichi, Yamada, Toshiyuki, Masaki, Shouta, Kitamura, Kohei, Kanemura, Tokumi, Suda, Hisao
• Format: Journal Article
• Language: Japanese
• Published: JAPANESE SOCIETY FOR VASCULAR SURGERY 19.05.2024
• Subjects: anterior lumbar interbody fusion; spinal surgery; vascular surgery
• ISSN: 0918-6778; 1881-767X
• DOI: 10.11401/jsvs.23-00084

Objective: Because of the introduction of new cages that can be used for the treatment of degenerative disc disease, spondylolisthesis and other painful spinal conditions, the anterior approach has been gaining popularity as an acceptable method for exposure of the anterior spine. Due to the potential seriousness of complications of the anterior approach such as major vascular injury, vascular surgeons in Western countries collaborate to help gain access to the lumbar spine. It is not common for vascular surgeons to participate in spinal surgery in Japan. This study aimed to evaluate the complications and challenges in anterior lumbar interbody fusion (ALIF) and provide guidance on these procedures. Methods: From August 2019 to January 2023, we gained access to the anterior lumbar spine during ALIF in 21 cases. We evaluated the patients’ conditions, operating time, bleeding events, major vascular complications, and problems with these procedures. Results: The mean patient age, operating time and bleeding volume were 64.9±12.3 years (male: 13 cases), 234.8±68.7 min and 197±167 mL, respectively. In 19 of the cases (90.5%), there were no complications such as uncontrolled bleeding, arterial complication, nerve injury, or death. Bleeding from the left common iliac vein and the median sacral vein was noted in two cases (9.5%). Hemostasis with suture was very difficult to achieve, because the operative field was very deep and narrow. So we controlled the bleeding using only compression at the affected site. Since control of bleeding is often challenging in ALIF, it is important to acquire the skills necessary to control it. Conclusion: Becoming an expert in anatomical techniques and knowledge of orthopedic surgery as well as in manipulation of vessels is essential when vascular and orthopedic surgeons work together in spinal surgery.