J Korean Orthop Assoc.  2017 Oct;52(5):448-452. 10.4055/jkoa.2017.52.5.448.

Vascular Injury in Posterior Lumbar Spinal Surgery

• Chung YW
• Chung SY
• Lee TM
• Yeo JH

• KMID: 2393518
• DOI: http://doi.org/10.4055/jkoa.2017.52.5.448

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.

Keyword

vascular system injuries; lumbar vertebrae; diskectomy

MeSH Terms

Aneurysm, False
Diskectomy
Hemorrhage
Humans
Iliac Artery
Lumbar Vertebrae
Stents
Vascular System Injuries*

Figure

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  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.

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  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.

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  Figure 3 Computed tomography (CT) (A) and 3-dimensional CT angiography (B) do not reveal any evidence of extravasation and aneurysm.

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  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.

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  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).

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