Complications of lumbar anterior retroperitoneal approach: What are the risks and their factors?

INTRODUCTION: Anterior lumbar retroperitoneal approach (ALRA) to the spine offers benefits over posterior approach, including better restoration of disc height and lumbar lordosis. However, this technique is not without risks. This study aimed to evaluate the complication rates and risk factors associated with ALRA. METHODS: A single-center retrospective study was conducted on patients who underwent ALRA between 2016 and 2020. Patients with less than six months follow-up or missing data were excluded. Surgical parameters, demographic data, medical history, and postoperative complications were collected and compared between patients with and without approach-related complications to determine risk factors. RESULTS: The study included 355 patients, mean age = 50 years. The majority (73.5%) of procedures were assisted by a vascular surgeon. The overall complication rate was 42%, with the most common being abdominal wall paresis (18%) and post-sympathectomy syndrome (11%). Incisional hernia was more frequent in patients with an ASA score ≥3 and those with a history of abdominal surgery. Extensive dissection increased the risk of abdominal wall paresis. Post-sympathectomy syndrome was more common at the L4-L5 level and when the left-side approach was used. Patients undergoing revision surgeries were more likely to be smokers. CONCLUSION: While the anterior approach is effective, it carries a notable risk of complications. Identifying and understanding these risk factors can help in preoperative patient counseling and tailoring surgical approaches to minimize risks. This study identified high ASA scores, previous abdominal surgeries, and extensive dissections as significant risk factors for complications. Further studies are needed to refine techniques and improve patient outcomes.