Combined arterial, venous, and ureteral injury complicating lumbar disk surgery

Complete ureteral necrosis after injury sustained during lumbar disc surgery: A case report

INTRODUCTION

Reports pertaining to ureteral injury sustained during lumbar disc surgery are rare; most ureteral injuries in this setting involve laceration or transection.

PATIENT CONCERNS

We report a rare case of a 55-year-old man who presented with complete left ureteral necrosis 20 days after sustaining ureteral transection during lumbar disc surgery.

DIAGNOSIS

The patient presented with seroperitoneum caused by left ureteral injury; post-operative histopathological examination of surgical specimen after discectomy had revealed ureter-like tissue. Exploratory laparoscopic surgery revealed necrosis of a long segment of ureter, which was not amenable to treatment with conventional methods.

INTERVENTION

We used a spiral bladder muscle flap with vascular pedicles to repair the ureteral defect.

OUTCOMES

Post-operative period was uneventful and the patient showed good recovery.

CONCLUSION

Spiral bladder muscle flap with vascular pedicles may be used to repair extensive ureteric injury.

Iatrogenic Ureteral Injury as a Complication of Posterior or Lateral Lumbar Spine Surgery: A Systematic Review of the Literature

OBJECTIVE

Iatrogenic ureteral injury associated with lumbar spine surgery is an uncommon but devastating complication with associated medicolegal implications.

METHODS

We performed a systematic review of the English language literature published between 1954 and 2019, accessed through 4 popular databases. We found 44 articles (28 case reports, 9 case-based reviews, 4 case series, 1 original article, 1 case illustration, and 1 pictorial) containing 46 cases of ureteral injuries after posterior or lateral lumbar spine surgery.

RESULTS

Except for 5 cases with insufficient data, 24 of the remaining 41 patients were female and 17 were male, with ages ranging from 16 years to 83 years. Excluding 4 cases without enough information, initial diagnoses of lumbar disc herniation (n = 33) or lumbar spinal stenosis (n = 4), spondylolisthesis (n = 3), degenerative disc disease (n = 1), and failed back surgery syndrome (n = 1) were reported from 18 countries; 54% of patients were from the United States, Japan, or Turkey. The interval from spinal surgery to restorative surgery ranged from <24 hours to 1 month to 1 year; in 48% of patients, it was >1 week, and 90% of patients recovered completely. Initial surgery was combined with vascular injury in 15% of patients.

CONCLUSIONS

Ureteral injury associated with lumbar spine surgery is overreported in developed or developing countries. It should be considered in the differential diagnosis of any patient who presents with symptoms of acute abdomen after lumbar spine surgery, and patients who underwent restorative surgery had a good prognosis.

Injury to major abdominal vessels during posterior lumbar interbody fusion. A case report and review of the literature

BACKGROUND CONTEXT

Numerous cases of injury to major abdominal vessels during the excision of a lumbar herniated disc have been reported, but no cases of injury during interbody fusion by a posterior approach have been described.

PURPOSE

To report on an injury to common iliac vessels during a posterior lumbar interbody fusion (PLIF) and discuss the causes and possible preventive measures.

STUDY DESIGN

A unique case report and a review of the literature.

METHODS

The hospital chart and autopsy report of a single patient were analyzed.

RESULTS

A 52-year-old woman with L4-L5 disc degeneration underwent PLIF. During scraping of the vertebral end plates, there was a sudden increase in blood flow from the disc space, however not copious, with no changes of vital parameters. When the patient was placed supine, severe hypotension and abdominal distension led to strongly suspect a lesion to abdominal vessels. At laparotomy, carried out by a vascular surgeon, a vast retroperitoneal hematoma was evacuated and the vascular lesions were repaired. Postoperatively, the patient continued to lose blood from the abdominal drains and after 4 hours, she was reoperated by another vascular surgeon, who found a diffuse hemorrhage from the small vessels in the surgical field. Soon after the surgery the patient died.

CONCLUSIONS

The lesions were produced by a shaver used for scraping the vertebral end plates. The absence of abundant bleeding from the disc space was possibly because of the compression of the iliac vessels by the pads of the frame on which the patient was lying. The causes of the lesions and possible prevention of similar injuries are analyzed.

Ureteric injury after lumbosacral discectomy: a case report and review of the literature

Herein, a case of ureteric injury was inflected during lumbo-sacral laminectomy is reported to be added to the previously published 15 cases. Ureteric injury is a rare complication that may be encountered during lumbar disc surgery. We traced 15 cases that were published in literatures allover the past years with different management techniques. To the best of our knowledge, we report the first case that was treated by ileal ureteric replacement. Special attention should be paid regarding ureteric injury during surgery. Despite rare incidence of such injury with laminectomy, there were some reportable complications. So, surgeons should be aware of prediction, early diagnosis, and possible management alternatives for such injuries to safe patients from unsuspected handicapping.

Vascular injury complicating lumbar disc surgery. A systematic review

OBJECTIVES

to review the literature concerning the early and late vascular complications of lumbar disc surgery.

METHODS

using the MEDLINE database, we reviewed all reports of vascular complications associated with surgical excision of a prolapsed disc via a posterior approach reported in the English literature since 1965.

RESULTS

we identified 98 cases of vascular complications for an incidence of 1-5 in 10000 disc operations. Early presentation is shock due to rupture of a large retroperitoneal vessel. Late complications include development of pseudoaneurysms and arteriovenous fistulas. Treatment of a vascular tear consisted mainly of primary suturing of the injured vessel. The preferred method for arteriovenous fistula and pseudoaneurysm repair was suturing from within the arterial lumen along with interposition grafting. Recently, endovascular techniques have been recommended, lowering the high morbidity and mortality related to conventional repair.

CONCLUSION

iatrogenic vascular injury during lumbar disc surgery, although rare, should be suspected if signs of circulatory instability are noted or if lumbar pain, leg oedema or high output cardiac failure develop months to years following such surgical procedures. However, these symptoms may arise during or immediately after surgery, requiring immediate intervention.

Ureteral injury after anterior lumbar interbody fusion. A case report

STUDY DESIGN

This case report presents a patient with ureter injury after anterior spinal fusion and its management.

OBJECTIVES

To present possible causes, symptoms, diagnostic approach, and management of this rare complication.

SUMMARY OF BACKGROUND DATA

The reported complications of anterior surgical approaches to the lumber spine have been predominantly vascular or neurologic. The susceptibility of the ureter to injury is emphasized by the description of an as-yet-unreported case of ureter laceration after anterior lumbar fusion.

METHODS

Ureter injury was diagnosed using computed axial tomography, ultrasonography-guided aspiration, and chemical analysis of the aspirate after anterior spinal fusion.

RESULTS

Early diagnosis of this injury prompted a ureter stent placement and prevented additional deterioration of renal function and infection.

CONCLUSIONS

The ureter is prone to injury if not identified and protected when sharp and pointed instruments are used for retraction. Abdominal mass, low-grade fever, and leukocytosis should prompt use of computed tomography or ultrasonography-guided aspiration.

Complete ureteral transection associated with percutaneous lumbar disk nucleotomy

A case of complete ureteral transection complicating percutaneous nucleotomy for disk herniation is reported. The ureteral lesion was contralateral to the percutaneous approach and was treated by intubated ureteroureterostomy, since complete section precluded endourological management.

Ureteral injury in lumbar disc surgery

Among retroperitoneal injuries in lumbar disc surgery ureteral transection is a rare complication and only 8 cases have been reported so far. They are analysed and a ninth case is added and described. In this case the complication was recognized immediately and successfully treated by end-to-end anastomosis of the ureter with an internal stent. Usually the diagnosis was delayed due to uncharacteristic symptoms (fever, haematuria, abdominal pain and distension, ileus, palpable mass etc.) which led to septic courses and nephrectomy in 3 cases. The anatomical relationship of the lumbar spine and retroperitoneal structures is illustrated by CT scans. Factors contributing to these injuries and ways of recognizing and preventing complications are discussed.

Arteriovenous fistula following lumbar disc surgery

Injury to the aorta, vena cava and iliac vessels is a recognized hazard of lumbar disc surgery (1-4). Haemorrhage may be manifest at the time, or postoperatively false aneurysm or arteriovenous fistula occurs. Four cases of arteriovenous fistula, 2 with associated false aneurysm, are described. Presentation varied between immediately postoperatively and 8 years later. In none of these injury suspected at the time of surgery.

Surgical injury to ureter

The incidence of surgical injury to the ureter varies from as low as 0.5% to as high as 30%. By being aware of various pitfalls in prevention, recognition, and treatment, the operating surgeon may perhaps minimize the incidence of surgical injuries to the ureter or their sequelae. The authors' experience with twenty-four surgical ureteral injuries is discussed and 5 cases are reported. In spite of a thorough knowledge of embryology, anatomy, and pathology predisposing to ureteral involvement, the possibility of ureteral injury must always be kept in mind.

Ureteral injury incident to lumbar disc surgery. Case report

✓ A case is reported in which combined vascular and ureteral injury occurred during lumbar disc surgery. The mechanism of injury is described and the importance of its early recognition emphasized.