Does structural compromise of the aorta in patients with aortic pathologies predict increased spinal and vascular complications and reoperations in patients undergoing anterior approach to the spine?
Objectives: Anterior spinal fusion (ASF) presents unique challenges, including the proximity of critical anatomic structures. Previous reports have detailed vascular injuries during exposure/approach; however, it is not well-documented whether structural aortic pathology, such as aneurysm, dissectio...
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| Main Authors: | , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Wolters Kluwer Medknow Publications
2024-12-01
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| Series: | Journal of Craniovertebral Junction and Spine |
| Subjects: | |
| Online Access: | https://journals.lww.com/10.4103/jcvjs.jcvjs_134_24 |
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| Summary: | Objectives:
Anterior spinal fusion (ASF) presents unique challenges, including the proximity of critical anatomic structures. Previous reports have detailed vascular injuries during exposure/approach; however, it is not well-documented whether structural aortic pathology, such as aneurysm, dissection, atherosclerosis, aortitis, or aortic tumors, impacts postoperative outcomes following anterior approach to the spine for spinal fusion.
Materials and Methods:
Using the New York State Statewide Planning and Research Cooperative System, thoracolumbar ASF patients with a history of aneurysm, dissection, atherosclerosis, aortitis, or aortic tumors (APath) were identified and matched to patients with no aortic pathologies (No-APath). The two cohorts were compared at 90-day and 2-year follow-up for complications, readmissions, and revisions. Multivariate binary stepwise logistic regression identified independent predictors of these outcomes.
Results:
Ninety-nine and 64 patients were included at 90-day and 2-year follow-ups, respectively. APath and No-APath had comparable demographics. Through 90-day follow-up, both cohorts had similar vascular complications and overall complications. No-APath patients had higher surgical complications (11.1% vs. 0%, P = 0.021). At 2-year follow-up, cohorts had comparable vascular complications, overall complications, and all other outcomes (P > 0.05). Neither group was observed to require any revisions through 2-year follow-up. The presence of a structural aortic pathology was not associated with increased odds of incurring adverse outcomes at 90-day and 2-year follow-ups.
Conclusions:
Structural aortic compromise in the setting of thoracolumbar ASF did not predispose patients to adverse vascular, spinal-related, or medical/surgical complications, nor to anterior spinal or vascular revision or repair through 2-year follow-up. These results highlight the need for well-powered studies to further delineate the risk of anterior spinal surgery in this cohort of patients. |
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| ISSN: | 0974-8237 0976-9285 |