# Prospective Analysis of Incisional Morbidity Associated With Anterior Surgical Approaches to the Lumbar Spine

## TL;DR

This study shows that anterior lumbar spine surgery has low incision-related complications and good cosmetic outcomes when performed carefully.

## Contribution

The study provides new prospective evidence on the safety and cosmetic outcomes of anterior lumbar approaches.

## Key findings

- Significant improvements in incision appearance, color, and pain were observed over two years.
- The complication rate was 9%, with no incisional hernias or bulging reported.
- No significant correlations were found between incision outcomes and patient or surgical factors.

## Abstract

Objective: Anterior approaches to the lumbar spine have been used extensively for various indications but they are also associated with unique complications and have been linked with higher incisional morbidity.This study aimsto evaluate incisional morbidity related to anterior lumbar surgeries and to assess how incisional outcomes correlate with patient and surgery-related factors.

Methods: Patients ≥18 years old and with planned anterior lumbar fusions from L1 to S1 were prospectively enrolled. Follow-up ended at two years, and patients who did not complete the follow-up were excluded. Incision was assessed for general appearance, width, color, cross-hatching, hypertrophy, and pain by using a validated scoring system and a visual analog scale (VAS). Patient and surgery-related factors were analyzed for possible correlations with complications or wound-related parameters.

Results: A total of 205 patients with a mean age of 54.4 ± 11.5 were included. Significant improvements were seen in color, hypertrophy, pain, and appearance of the incision. At two years, the mean patient-based VAS for appearance was 8.6 while surgeon-based VAS was 8.8. The total rate of complications was 9%, with no incisional hernia or bulging. No significant relation was found between incision-related parameters and the demographic and surgical variables.

Conclusion: This study reports acceptable cosmetic results and no chronic pain after anterior lumbar surgery, which is contrary to previous reports. Together with a low total rate of complications, anterior approaches are safe when carefully executed, and have low morbidity.