Background: Anterior lumbar access is commonly used for anterior lumbar interbody fusion (ALIF) and lumbar disc replacement (LDR) but carries a risk of potential vascular complications especially venous injuries, which may result in significant morbidity if not managed in time. This study aims to evaluate imaging utilisation, vascular complications and outcomes in the early adoption phases of anterior lumbar access surgery.

Methods: We conducted a retrospective review of 25 patients who underwent anterior lumbar access at our institution between January 2024 and December 2025. Pre-operative vascular characteristics, intraoperative variables (including procedure type, operative time and number of levels operated), indications for CT imaging and associated findings were studied.

Results: 25 patients underwent anterior lumbar access surgery between January 2024 and December 2025 which comprised of 18 LDR and 7 ALIF cases. One LDR patient sustained an intra-operative left common iliac vein injury which was repaired intraoperatively without further complications. Post-operative CTs were performed for 11 (44%) patients due to clinical concerns. These were suspected intra-abdominal bleed (n=4), abdominal pain (n=4), concerns regarding implant positioning (n=2) and acute limb ischemia (n=1). In the patient with suspected acute limb ischemia, the post-operative CT scan revealed an external iliac artery non-occlusive thrombus which was successfully treated with embolectomy. No significant findings were reported from the other post-operative CTs obtained. All patients who underwent post-operative CT imaging recovered without further sequelae. On average, those requiring post-operative CT imaging had longer operative times and underwent multilevel procedures.

Conclusion: A multidisciplinary approach involving spine and vascular surgery teams was employed during the early adoption phases of anterior lumbar access surgery. There was a low clinical threshold for obtaining post-operative CT scans. Our early experience reflects a low rate of clinically significant vascular complication and low diagnostic yield of post-operative CT imaging. Specifically, our findings are consistent with the wider literature that venous injuries are more likely than arterial injuries. We recommend an established spine-vascular surgery workflow for the safe implementation of anterior lumbar access procedures.