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J Neurosurg Spine. 2014 Nov;21(5):794-8. doi: 10.3171/2014.7.SPINE131146. Epub 2014 Sep 5.

First report of major vascular injury due to lateral transpsoas approach leading to fatality.

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Department of Neurological Surgery, Rutgers University-New Jersey Medical School, Newark, New Jersey.


Extreme lateral interbody fusion (XLIF) has gained popularity among spine surgeons for treating multiple conditions of the lumbar spine. In contrast to the anterior lumbar interbody fusion (ALIF) approach, the minimally invasive XLIF approach affords wide access to the lumbar disc space without an access surgeon and causes minimal tissue disruption. The XLIF approach offers many advantages over other lumbar spine approaches, with a reportedly low complication profile. The authors describe the first fatality reported in the literature following an XLIF approach. They describe the case of a 50-year-old woman who suffered a fatal intraoperative injury to the great vessels during a lateral transpsoas approach to the L4-5 disc space.


ALIF = anterior lumbar interbody fusion; ALL = anterior longitudinal ligament; AP = anteroposterior; IVC = inferior vena cava; VB = vertebral body; XLIF = extreme lateral interbody fusion; complication; extreme lateral interbody fusion; lateral transpsoas approach; lumbar spine; vascular injury

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