Vascular surgeons often expose and protect significant blood vessels during the procedure.
It is the job of the neurosurgeon or orthopaedic surgeon to advise when an ALIF is an appropriate operation to help with your symptoms and when an anterior approach is the best option as opposed to an approach from the rear or side of the spine. Vascular surgeons are responsible for providing help to the spinal surgeons by exposing the degenerative disc, as the large arteries and veins of the abdomen towards the legs must be moved to access the disc space.
Vascular surgeons must move the large arteries and veins in variable amounts in different directions, depending on the patient’s anatomy and which spinal disc level must be repaired.
An L5/S1 exposure can be done through a horizontal incision that can be hidden behind one’s underpants or bikini line. A horizontal cut is preferable to most patients as the scar is less noticeable. Unfortunately, the L4/L5 disc space can not be exposed as easily through a lower horizontal incision and is done so using a vertical incision that usually stops below the belly button
The intestines are wrapped in an envelope called the ‘peritoneum’. This envelope is not entered. Instead, the entire envelope is pushed out of the way to one side to gain access to the back of the abdomen, where the spine and great vessels live
Depending on the individual lie of vessels, these can be moved in multiple directions, as demonstrated in the picture below
Figure 3 – Options for exposing the L4/5 disc space
ALIF surgery has risks that need to be understood and considered before agreeing to surgery.
Every surgery that is performed has a risk of causing anaesthetic complications, allergic reactions, heart attack or stroke and potential death.
Specific risks as they pertain to spinal disc exposures include:
Massive bleeding – The Iliac vein and artery can be damaged, and blood loss can be swift and life-threatening. Every spinal access case uses a device to wash and return your blood to you.
Blockages to arteries or veins – after prolonged mobilisation and retraction of the great arteries and veins, they can form clots, which can dislodge and go down the arteries towards the does and cause a lack of blood supply to the lower limb, or can form in the veins and go up towards the lungs and cause death through lack of oxygen to the body through the lungs.
Sexual dysfunction – nerves involved in erections and ejaculation are located in front and to the side of the iliac vessels. They can be damaged in 3-5% of patients, which can lead to ‘retrograde ejaculation’, which means semen and sperm will travel back into the bladder upon the organism rather than forward through the urinary hole of the penis. Retrograde ejaculation can make men infertile unless they have the sperm surgically harvested from their testicles, as the standard delivery route does not work.
Sympathetic nerve injury – similar to sexual dysfunction, damage to the sympathetic nerves causes one foot to be warmer than the other. Typically, your left foot may become slightly warmer. It can also sweat more. It may be temporary or permanent.
Infection – rarely, the surgical wound can become infected. A deep surgical infection that involves metalware disc replacement is a severe condition, with those risks best discussed by the spinal surgeon.
Injury to the ureter – the tube drains urine from the kidney. If it is damaged, it requires more surgery, or the kidney with the damaged ureter will eventually stop working.
Temporary bowel paralysis (ileus) – some patients have their intestines go to sleep for 3-7 days after this operation. It is uncommon but is very uncomfortable and significantly delays recovery. It always resolves
Bowel injury – The bowel can be injured when it is moved out of the way.
Aortic dissection is a complicated condition that requires a long conversation about its implications and cannot easily be explained through website content delivery.
An aortic dissection is a tear in the inner layer of the aorta, causing blood to flow between the layers of the aortic wall causing a life-threatening emergency.
Consulting locations
WOLLONGONG
Artery and Vein Clinic
402 Crown St
Wollongong
NSW 2500
GREGORY HILLS
Artery and Vein Clinic
Soma Centre
Suite 8/7, Gregory Hills drive
Gregory hills
NSW 2557
Orange
Artery and Vein Clinic
117 Molder st
Orange
NSW 2800
Contact Info
Wollongong
Phone: (02) 4226 9333
Fax: (02) 4229 4006
Gregory Hills
Phone: (02) 4601 1055
Fax: (02) 4601 1058
Orange
Phone: (02) 4601 1055
Fax: (02) 4601 1058
Healthlink EDI: wgvascul
Office Hours
9am – 4:30pm Monday to Friday
Phone Hours
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