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Wang J, Hu Y, Wang H. Acute abdominal aortic injury during posterior lumbar fusion surgery: A case report. Medicine (Baltimore) 2022; 101:e30216. [PMID: 36107582 PMCID: PMC9439786 DOI: 10.1097/md.0000000000030295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Vascular injury is a serious complication during lumbar fusion surgery, leading to massive blood loss and life-threatening circulatory failure. In this study, we report on a patient with abdominal aorta injury at L2-L3 level during lumbar fusion surgery via posterior approach. Fortunately, our patient was successfully managed with prompt intervention. PATIENT CONCERNS A 73-year-old female was admitted to our department of low back and bilateral leg pain with claudication for over 6 months. DIAGNOSIS L2-S1 spinal canal stenosis, with abdominal aorta injury at the L2-L3 level during lumbar fusion surgery via a posterior approach. INTERVENTIONS L2-S1 decompression and fusion via a posterior approach was employed for spinal canal stenosis. Transluminal angioplasty with stent placement was successfully performed to stop the bleeding. OUTCOMES During the procedure, it was decided that staunching the active bleeding was necessary and attention should be paid to the vital signs and blood pressure. Vascular surgical intervention was immediately scheduled when the blood pressure dropped. After stent placement, hemodynamic parameters stabilized. CONCLUSION In this case report we review the prevalent sites, predisposing risk factors, diagnosis, and treatment of acute abdominal aortic injury during posterior lumbar fusion surgery, in view of our case findings. Although the incidence of vascular injury during lumbar fusion surgery is low, it is often easily overlooked. Consequently, during surgery, physicians should always be alert to the risk of vascular injury and master its clinical characteristics. Once injury is suspected, active and effective measures should promptly be taken for diagnosis and treatment to avoid serious adverse consequences.
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Affiliation(s)
- Jianhe Wang
- Department of Orthopedics, Dalian Municipal Central Hospital Affiliated of Dalian Medical University, Dalian City, China
- The First Affiliated Hospital Of Dalian Medical University, Dalian City, China
| | - Yunxiang Hu
- Department of Orthopedics, Dalian Municipal Central Hospital Affiliated of Dalian Medical University, Dalian City, China
| | - Hong Wang
- Department of Orthopedics, Dalian Municipal Central Hospital Affiliated of Dalian Medical University, Dalian City, China
- *Correspondence: Hong Wang, Department of Orthopedics, Dalian Municipal Central Hospital Affiliated of Dalian Medical University, No. 826, Southwestern Road, Shahekou District, Dalian City, Liaoning Province 116021, China (e-mail: )
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Denli Yalvac ES, Balak N. The probability of iatrogenic major vascular injury in lumbar discectomy. Br J Neurosurg 2020; 34:290-298. [DOI: 10.1080/02688697.2020.1736261] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Emine Seyma Denli Yalvac
- Department of Cardiovascular Surgery, Göztepe Education and Research Hospital, Istanbul Medeniyet University, Istanbul, Turkey
| | - Naci Balak
- Department of Neurosurgery, Göztepe Education and Research Hospital, Istanbul Medeniyet University, Istanbul, Turkey
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Abdominal Vascular Injury During Posterior Lumbar Discectomy, Experience from Three Cases and Review of Literature. Spine (Phila Pa 1976) 2019; 44:E1227-E1230. [PMID: 31095120 DOI: 10.1097/brs.0000000000003100] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Case series and review of literature. OBJECTIVE To report three cases of vascular injury during posterior lumbar disc surgery, two of these occurred during open discectomy, and one during an endoscopic surgery. Aim is to highlight importance of early diagnosis and prompt steps taken to prevent morbidity and mortality. SUMMARY OF BACKGROUND DATA Vascular injury during lumbar discectomy is rare injury. Also no case has been reported so far occurring during an endoscopic discectomy. METHODS Three patients were treated for lumbar intervertebral disc prolapse, two had undergone open posterior discectomy while the third patient underwent endoscopic discectomy and all of them were diagnosed to have suffered an abdominal vascular injury. RESULTS In two cases pseudo-aneurysm was found while third case was diagnosed as an arterio-venous fistula. All the three cases were managed with endovascular stenting and followed for a minimum period of 2 years. No further complications were detected. CONCLUSION Vascular injury during a disc surgery is difficult to diagnose due to the rarity of occurrence and subtle signs which need to be recognized to start early management. LEVEL OF EVIDENCE 5.
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Liu B, Ye K, Gao S, Liu K, Feng H, Zhou F, Tian Y. The summary of experience of abdominal vascular injury related to posterior lumbar surgery. INTERNATIONAL ORTHOPAEDICS 2019; 43:2191-2198. [PMID: 30643934 DOI: 10.1007/s00264-018-4262-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Accepted: 11/27/2018] [Indexed: 10/27/2022]
Abstract
PURPOSE To study the clinical and pathophysiologic characteristics and summarize the experience of treatment of abdominal vascular injury related to lumbar surgery. METHODS We analyzed patients who suffered abdominal vascular injury during lumbar surgery in our hospital retrospectively and reviewed related literature in the PUBMED database from 2002 to 2017. Combined with the existing treatment options and outcomes, we investigated further and summarized our findings. RESULTS With the data from our hospital, four cases of injuries were included, i.e., left common iliac artery and vein (CIA and CIV), left internal iliac artery, and inferior vena cava. Almost all of the patients (one exception) manifesting unstable haemodynamics were primarily treated by traditional vessel suture. After treatment, two patients died eventually, while the others recovered well at follow-up. With the reported data, 77 patients with the most frequently type of laceration (58.4%) were included. For vascular laceration, unstable haemodynamics was diagnosed in most of the patients (88.9%); CIA and CIV accounted for the all the most common patients (78.7%). Extracted from these data, traditional surgical method was selected to repair laceration prevalently (86.7%), while arteriovenous fistula and pseudoaneurysm were treated with an interventional procedure. Negative outcomes included two deaths, two suffered lower limb deep vein thrombosis, and two suffered graft infection. CONCLUSIONS Different treatment choices should be conducted depending on different injury characteristics and patients' condition. Moreover, early recognition and prompt treatment are critical components to successful rescue. When a vascular injury is suspected, ultrasonography and positive abdominal exploration are recommended together with unified leadership in the rescue team.
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Affiliation(s)
- Bingchuan Liu
- Department of Orthopedics, Peking University Third Hospital, Beijing, 100191, People's Republic of China
| | - Kaifeng Ye
- Department of Orthopedics, Peking University Third Hospital, Beijing, 100191, People's Republic of China
| | - Shan Gao
- Department of Orthopedics, Peking University Third Hospital, Beijing, 100191, People's Republic of China
| | - Kaixi Liu
- Anesthesiology Department, Peking University Third Hospital, Beijing, 100191, People's Republic of China
| | - Hui Feng
- Department of Orthopedics, Peking University Third Hospital, Beijing, 100191, People's Republic of China
| | - Fang Zhou
- Department of Orthopedics, Peking University Third Hospital, Beijing, 100191, People's Republic of China
| | - Yun Tian
- Department of Orthopedics, Peking University Third Hospital, Beijing, 100191, People's Republic of China. .,Peking University Third Hospital, 49 North Garden Rd., Haidian District, Beijing, People's Republic of China.
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Postacchini R, Cinotti G, Postacchini F. Injury to major abdominal vessels during posterior lumbar interbody fusion. A case report and review of the literature. Spine J 2013; 13:e7-11. [PMID: 23219458 DOI: 10.1016/j.spinee.2012.11.016] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2012] [Revised: 09/02/2012] [Accepted: 11/08/2012] [Indexed: 02/03/2023]
Abstract
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.
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Affiliation(s)
- Roberto Postacchini
- Italian University Sport and Movement, Piazza Lauro de Bonis 15, Rome, Italy
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Delasotta LA, Radcliff K, Sonagli MA, Miller L. Aberrant iliac artery: far lateral lumbosacral surgical anatomy. Orthopedics 2012; 35:e294-7. [PMID: 22310424 DOI: 10.3928/01477447-20120123-28] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
A 44-year-old man presented after 3 weeks of progressively worsening atraumatic onset pain in the right anteromedial thigh. The pain was sharp and radiated to the anteromedial shin and medial foot. The patient had no associated weakness, numbness, or bowel/bladder dysfunction. Nonsteroidal anti-inflammatory, pain, and neuropathic-relieving drugs had limited effect. He underwent interlaminar injections, which provided transient relief of his shin symptoms. After conservative management failed, a spine surgeon (not affiliated with our practice) recommended an anterior lumbar interbody fusion via far lateral approach. The patient presented to our spine clinic for a second opinion. Closed magnetic resonance imaging revealed an aberrant iliac artery impinging on the lumbar plexus and a foraminal herniation at L4-L5 on the right, an orientation more lateral than expected or seen on the contralateral side. We recommended physical therapy that focused on core strength and adequate stretching prior to considering surgery. The patient's symptoms have since resolved. Common iliac artery anomalies are rare. No known incidence exists. The finding in this case was incidental and, if missed, could have led to vascular compromise. To prevent such an injury during minimally invasive (transpsoas lateral approach) spine surgery, we recommend careful examination of radiographs for aberrant vessels.
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Erkut B, Unlü Y, Kaygin MA, Colak A, Erdem AF. Iatrogenic vascular injury during to lumbar disc surgery. Acta Neurochir (Wien) 2007; 149:511-5; discussion 516. [PMID: 17387429 DOI: 10.1007/s00701-007-1132-2] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2006] [Accepted: 02/19/2007] [Indexed: 11/25/2022]
Abstract
We report two patients who sustained vascular injury while undergoing intervertebral disc surgery at the lumbar four and five level. Each patient suffered from massive bleeding and shock, urgent laparatomy was performed, and the vascular injuries were successfully primarily repaired. The experience prompted us to review reports in the literature since 1965 of vascular complications associated with surgical excision of hernia disc via a posterior approach. From our analysis, we highlight the clinical features and management, emphasising that rapid diagnosis and immediate intervention can result in a favourable outcome, as in our patients.
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Affiliation(s)
- B Erkut
- Department of Cardiovascular Surgery, Medical Faculty of Atatürk University, Erzurum, Turkey.
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Lacombe M. Les complications vasculaires de la chirurgie discale lombaire. ACTA ACUST UNITED AC 2006; 131:583-9. [PMID: 16872577 DOI: 10.1016/j.anchir.2006.06.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2006] [Accepted: 06/22/2006] [Indexed: 11/19/2022]
Abstract
Vascular complications of lumbar disc surgery are rare (about 0,04% of discectomies) but very severe. Great variations of the anatomical lesions and of their clinical aspects may be observed. These lesions are often unrecognised during the operation and they are sometimes identified several years after the injury. The treatment is mainly surgical but percutaneous endovascular treatment has been recently performed successfully in several patients.
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Affiliation(s)
- M Lacombe
- Service d'Urgences, Hôpital Beaujon, 10, boulevard du Général-Leclerc, 92118 Clichy cedex, France.
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10
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Houten JK, Frempong-Boadu AK, Arkovitz MS. Bowel injury as a complication of microdiscectomy: case report and literature review. ACTA ACUST UNITED AC 2004; 17:248-50. [PMID: 15167343 DOI: 10.1097/00024720-200406000-00014] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Intestinal injury is a rare complication of lumbar disc surgery, resulting from inadvertent penetration of the anterior annulus fibrosus and anterior longitudinal ligament. Patients typically complain of abdominal pain and distention developing over the course of several days. Imaging with plain upright chest radiographs or abdominal computed tomography may demonstrate free air in the abdominal cavity. We report a case of intestinal perforation after microscopic lumbar discectomy and present the diagnostic postoperative imaging. In addition, we review the relevant literature and discuss techniques that may be employed to avoid this complication.
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Affiliation(s)
- John K Houten
- Department of Neurosurgery, Albert Einstein College of Medicine, Bronx, New York 10467, USA.
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Papadoulas S, Konstantinou D, Kourea HP, Kritikos N, Haftouras N, Tsolakis JA. Vascular injury complicating lumbar disc surgery. A systematic review. Eur J Vasc Endovasc Surg 2002; 24:189-95. [PMID: 12217278 DOI: 10.1053/ejvs.2002.1682] [Citation(s) in RCA: 204] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
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.
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Affiliation(s)
- S Papadoulas
- Department of Surgery, Vascular Surgery Unit, University Hospital of Patras, Patras, Greece
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Harrington JF. Far lateral disc excision at L5-S1 complicated by iliolumbar artery incursion: case report. Neurosurgery 2001; 48:1377-9; discussion 1379-80. [PMID: 11383746 DOI: 10.1097/00006123-200106000-00045] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE AND IMPORTANCE Paramedial approaches to far lateral discs at the L5-S1 space joint have advantages but may also bring the surgical space closer to large branch arteries of the internal iliac artery. I report incursion into an iliolumbar artery that required laparotomy to control hemorrhage. Surgeons performing extraforaminal disc explorations at L5-S1 need to evaluate preoperative magnetic resonance imaging scans for an enlarged iliolumbar artery near the disc space. CLINICAL PRESENTATION The patient presented with a right L5 radiculopathy and a far lateral disc at L5-S1, as indicated by analysis of her magnetic resonance imaging scan. INTERVENTION A midline incision and an extraforaminal exposure were performed. Arterial bleeding occurred when an anular disc fragment was removed with a pituitary rongeur under direct vision with microscopic magnification. Emergency laparotomy demonstrated hemorrhage from a branch of the internal iliac artery 2 cm from its origin. CONCLUSION Iliolumbar artery variants may be at the margins of extraforaminal disc exposure at L5-S1. Preoperative magnetic resonance imaging scans should be evaluated for this vasculature structure.
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Affiliation(s)
- J F Harrington
- Department of Neurosurgery, Brown University School of Medicine, Providence, Rhode Island
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Harrington JF. Far Lateral Disc Excision at L5–S1 Complicated by Iliolumbar Artery Incursion: Case Report. Neurosurgery 2001. [DOI: 10.1227/00006123-200106000-00045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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