In Brief:
Previous osteomyelitis or discogenic infection, previous anterior spinal surgery, spondylolisthesis, osteophyte formation, transitional lumbosacral vertebra, and anterior migration of interbody device point to an increased risk of vascular injury during anterior lumbar spinal surgery. Topical agents are an important management adjunct. Postoperative surveillance for proximal deep vein thrombosis, by magnetic resonance venography of the pelvic veins, should be performed after venorrhaphy.