Complications of anterior-to-psoas and their avoidance and treatment

Abstract

The anterior-to-psoas (ATP) approach in lumbar fusion offers advantages but carries risks of vascular, neural, and ureteral injuries, as well as postoperative ileus (POI). Vascular injuries may cause significant hemorrhage, while neural complications can result in neurologic deficits and autonomic dysfunction. Ureteral injury, though rare, may lead to renal failure if undiagnosed. POI is associated with excessive careless manipulations causing local inflammations and pain. Preventive strategies, including meticulous surgical techniques, neuromonitoring, and careful tissue handling, are crucial to minimize complications and improve patient outcomes. This review highlights the importance of understanding and mitigating these risks to enhance the safety and efficacy of ATP procedures.