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Abstract
Vascular complications are uncommon, but it may pose a serious problem in posterior spinal surgery. Vascular injury during lumbar spinal surgery should be suspected if symptoms of circulatory instability are noted. If vascular injury is suspected, a contrast enhanced computed tomography should be checked and proper management, i.e., interventional treatment or surgery should be performed. To date, there have only been a few reports regarding vascular injuries during posterior lumbar spinal surgery. Clinicians should pay attention to signs of vascular injury during posterior spinal surgery, and accordingly, promptly perform treatment. In two patients with retroperitoneal hemorrhage, extravasation of the common iliac arteries was successfully repaired. One patient with pseudoaneurysm was treated by stent placement.
Figures and Tables
Figure 1
(A) Anteroposterior plain radiograph shows a screw fixation with interbody fusion at the L5–S1 level. (B) Lateral plain radiograph shows a fusion state at the L5–S1 level. (C) T2-weighted sagittal magnetic resonance imaging shows a disc herniation at the L4–5 level.
Figure 2
(A) After discectomy, computed tomography (CT) shows hematoma in retroperitoneum (white arrow) and extravasation with a leakage of dye at the left common iliac artery (black arrow). (B) After exploration and primary repair of the left common iliac artery, CT shows no evidence of extravasation and aneurysm.
Figure 3
Computed tomography (CT) (A) and 3-dimensional CT angiography (B) do not reveal any evidence of extravasation and aneurysm.
Figure 4
(A) Lateral plain radiograph shows normal curvature on the lumbar spine. (B) T2-weighted sagittal magnetic resonance imaging shows a disc herniation at the L4–5 level.
Figure 5
(A) Arrow indicates an about 5 mm sized pseudo-aneurysm in the right common iliac artery on computed tomography (CT). (B) Follow-up CT was taken after two weeks. Arrow indicates an aneurysm increased about 10 mm sized at CT. Covered stent (each 5 mm bare segment at both ends, white arrows) deployment was performed with a successful result on the lateral plain radiograph (C) and CT angiography (D).
References
1. Ewah B, Calder I. Intraoperative death during lumbar discectomy. Br J Anaesth. 1991; 66:721–723.
2. 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; 24:189–195.
3. DeSaussure RL. Vascular injury coincident to disc surgery. J Neurosurg. 1959; 16:222–228.
4. Anda S, Aakhus S, Skaanes KO, Sande E, Schrader H. Anterior perforations in lumbar discectomies. A report of four cases of vascular complications and a CT study of the prevertebral lumbar anatomy. Spine (Phila Pa 1976). 1991; 16:54–60.
5. Ganesan C, Petrus L, Ross IB. Regarding the possibility of anterior vascular injury from the posterior approach to the lumbar disc space: an anatomical study. Spine (Phila Pa 1976). 2012; 37:E1371–E1375.
6. Bolesta MJ. Vascular injury during lumbar diskectomy associated with peridiskal fibrosis: case report and literature review. J Spinal Disord. 1995; 8:224–227.
7. Kopp R, Beisse R, Weidenhagen R, et al. Strategies for prevention and operative treatment of aortic lesions related to spinal interventions. Spine (Phila Pa 1976). 2007; 32:E753–E760.
8. Skippage P, Raja J, McFarland R, Belli AM. Endovascular repair of iliac artery injury complicating lumbar disc surgery. Eur Spine J. 2008; 17:Suppl 2. S228–S231.
9. Kim HS, Chong HS, Nanda A, et al. Vascular injury in thoracolumbar spinal surgeries and role of angiography in early diagnosis and management. J Spinal Disord Tech. 2010; 23:418–424.
10. Bingol H, Cingoz F, Yilmaz AT, Yasar M, Tatar H. Vascular complications related to lumbar disc surgery. J Neurosurg. 2004; 100:3 Suppl Spine. 249–253.
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