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Anterior Lumbar Interbody Fusion

Orthoracle Forums Spine Anterior Lumbar Interbody Fusion

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  • #96790
    AvatarNeil Upadhyay
    Participant

    Should a vascular (or access) surgeon be present for all Anterior Lumbar Interbody Fusions? I understand this is the case in the USA.

    #98616
    AvatarAndrew Young
    Participant

    This is not only common in the USA but also parts of the UK it seems

    I think I may complicate matters – I tend to want a vascular surgeon to ‘hold my hand’ for L4/5 but I am actually fairly happy for L5/S1.

    Do you think that it also depends on local protocols? Some places have vascular surgeons in the same building whom they pre-warn whilst my local vascular service is in a separate hospital.

    Due to this we are in the process of organising on site vascular support for an increasing number of our anterior spinal cases.

    #98618
    AvatarStephen Morris
    Participant

    My personal view is that is depends on your experience, training, and frequency of performing these cases. If you do not do it regularly and are not familiar handling blood vessels, you should probably have an access surgeon. If, however, you perform this regularly and are familiar with structures in this area, you may be more familiar with the approach than a vascular surgeon who does not normally perform a retro-peritoneal approach.

    For these reasons, I perform anterior approaches myself but I ensure there is a vascular surgeon available in the hospital before I start the case and that I have notified them that the case is going ahead. If it is a revision anterior procedure or a primary anterior procedure for infected posterior implants or interbody cage, the vessels can be very stuck down and I will have a vascular surgeon assisting from the start of the case.

    It would be interesting to hear from surgeons working in units where vascular surgery is not on site and if they do anything differently.

    #110074
    AvatarAshish Diwan
    Participant

    Using a “run-of-the-mill” vascular surgeon has its own issues. When I used a vascular surgeon, they were focussed on isolating the vessels, essentially skeletanising the vessels. The consequent sympathetic issues with warm legs was extremely common. I hence moved on to using a laproscopic surgeon who was happy to work via smaller incisions and brought some laproscopic ligation tools to the surgery. This was extremely useful in clipping the ascending lumbar without a massive overexposure of vessels.

    I hence like the term “Access Surgeon” better. A “true vascular surgeon” is required if and when disaster strikes and one needs things like graft/endovascular temporary blockage/ligation etc….

    You need a “team” where you work with the access surgeon to define the scope of exposure, how retarctors will be placed, How you use Hohmanns (if you use them), etc. Also define clearly when they can scrub off…

    The difference in UK Vs US Vs Aus has also to do with economics.

    Needless to say, if someone undertakes ALIF in a Hospital without Vascular Surgical Facility – it is misplaced bravado at best and stupidity at worst.

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