Preventing Vascular Injury During Spinal Surgery and Management of Vascular Complications

Recent advances in spinal surgery, particularly oblique lateral interbody fusion (OLIF), have enabled minimally invasive access to the lumbar spine through an anatomical corridor in front of the psoas muscle. Although OLIF25 provides safe access to the L1–L5 region and OLIF51 extends this to the L5/S1 region, these techniques carry a risk of major vascular injury, with a reported incidence of approximately 3.6%. Therefore, the prevention and management of vascular complications are critical for ensuring patient safety. Preoperative contrast-enhanced computed tomography (CT) with three-dimensional (3D) reconstruction is essential for measuring vessel position and distance and visualising contralateral vascular anatomy, thereby reducing the risk of inadvertent injury. Intraoperatively, any vascular injury must be managed with compression to maintain blood flow, which provides time for haemostatic preparations. Arterial injuries can be controlled using figure-of-eight full-thickness sutures, venous injuries using purse-string sutures, and fragile vessels using horizontal mattress sutures with pledgets. If the bleeding originates from inaccessible contralateral vessels, haemostatic agents can be used for temporary control, followed by definitive endovascular repair if necessary. Mastery of these preventive strategies and repair techniques enables safer Anterior Lumbar Interbody Fusion (ALIF) and OLIF procedures and reduces the risk of life-threatening vascular complications.