The risks from the anterior approach to the spine include retrograde ejaculation, as discussed, and possible damage to blood vessels in the area. The other complication is an ileus where intestines do not work properly after surgery. This typically lasts for a few days.
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The most common is incisional pain. Others include hernia or a generalized bulge in the incision area. Often, it takes a few to several days for a normal bowel schedule to return.
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Anesthesia, infection, failure of fusion, blood loss, nerve injury, pneumonia, urinary tract infection, persistent pain, loss of bowel and bladder; the potential list of complications is endless. A careful discussion of your particular procedure is critical to understanding which potential complication is a real risk for you.
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In the front of the spine in the lumbar region you have your intestines and major blood vessels, so those are always at risk for injuries during an anterior approach. I use a general or vascular surgeon to help me out with that approach. In adult males, there is a risk for something called retrograde ejaculation, especially in the L4-5 region if you go from the front. There are some nerves that affect the reproductive function of males. It is not erectile dysfunction, but it is retrograde meaning backwards ejaculation. So if I have male patient and we are considering going in from the front, then that is a specific risk I need to talk to the patient about. But if they are not interested in having children, then it is not such a major risk.
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There are certain complications associated with approaching the lumbar spine from the anterior, including hernias, vascular complications or urological complications. For this reason, this type of surgery is usually performed in conjunction with a vascular or general surgeon that performed the approach for the spine surgeon. Some spine surgeons do the surgery by themselves - it really depends on what is the standard of care in the community. In addition, in young males, retrograde ejaculation, a type of sexual dysfunction, is another risk. The surgeon, of course, will consider this when selecting this particular approach to the spine.
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Although the risks associated with approaching the spine through the abdomen are infrequent, they are certainly worth reviewing with your surgeon. The specific risks associated with this approach include injury to the neurovascular structures that are close to the spine. Such injury could result in bleeding or infertility (males). Other potential risks include hernias, blood clots, or incomplete bony fusion (pseudarthrosis). These risks are greater when a patient has had previous abdominal surgery. Many spinal surgeons elect to work alongside a vascular surgeon to reduce the complications associated with the anterior approach.
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Anterior procedures run the risk of damage to the blood vessels, retrograde ejaculation, damage to the sympathetic nerves to the legs, damage to the motor or sensory nerves to the legs, damage to the internal organs, and failure of the fusion to become solid.
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Like any other surgery, spinal surgery carries the risk of infection, bleeding, need for transfusions, nerve damage, bowel, bladder, and sexual dysfunction as well as medical complications, such as heart attack, stroke, blood clots, or death. There is always the possibility of worsening the pain and requiring additional surgeries. The anterior approach involves the additional risks of affecting the major organs in the abdomen and of causing retrograde ejaculation in men. This means they may lose their ability to eject sperm during orgasm. In the hands of a properly trained spinal surgeon, however, these risks can be minimized.
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The risks of spinal surgery are too numerous to record here. However, anterior lumbar spine approaches carry an increase risk to the vascular structures (especially the iliac vein), to the sympathetic chain and lumbosacral plexus, to the ureter and bladder, and depending on the location impaired sexual function (especially in men).
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The anterior (front) approach to the spine is generally accompanied by a skilled vascular surgeon. Major potential complications associated with this procedure include blood vessel damage and sexual dysfunction in males.
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The major risks of going in through the front are the great vessels. In order to have access to the disc spaces you have to immobilize the aorta and the vena cava. A trained vascular surgeon or a trained spine surgeon can minimize these risks. But that's the major risk. There are many benefits to an anterior approach. But the risks are mostly vascular.
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Infection, blood loss, pneumonia, etc.
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The risks of going in from the front are specific injury to the intestines, arteries, veins or other abdominal organs. Men have a risk of sexual problems afterwards.
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From the front there is the risk to major blood vessels, which would result in major hemorrhages as well as injury to the abdominal contents, which includes the intestines, though this is very rare. There is a risk of injury to the nerves that could result in retrograde ejaculation.
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Approaches from the front are generally very safe, but there is a very small risk of injury to major blood vessels, the bowel or nerves that contribute to sexual function in males. Other risks also apply, such as infection, bleeding, failure to fuse, implant failure, and nerve injury. Incomplete pain relief or the need for additional surgery is always a concern.
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Some of the risks associated with the anterior approach include iliac-vessel damage, blood clot formation, and retrograde ejaculation in males.
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Fusion through the abdomen can result in problems with the muscles of the abdominal wall (hernia), injury to the bowel, urinary tract, major blood vessels to the legs, nerves to the legs, and the nerves to the bladder/bowel.
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Certainly it is a very safe procedure, but there are complications associated with it. You have a large number of blood vessels in the way and they have to be careful retracted out of the way so that the surgery can be performed. Certainly there is a risk that those vessels could be damaged.
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The risks of going in from the front are specific injury to the intestines, arteries, veins or other abdominal organs. Often times a general or vascular surgeon may assist in the surgical approach to the spine. Men have a small risk of sexual problems afterwards.
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