Vascular and urological injuries in lumbar discectomy: uncommon complications. A report of two cases
DOI:
https://doi.org/10.59156/revista.v40i01.789Keywords:
Intraoperative complications, Lumbar discectomy, Urological injuries, Vascular injuriesAbstract
Background: disc herniation surgery is a routine procedure in the practice of spine surgeons, with multiple techniques and access routes described, open microdiscectomy being the current standard. As with any surgical procedure, it is not without complications. Vascular and urological injuries are uncommon complications and are rarely reported in scientific literature.
Objectives: to describe 2 clinical cases of uncommon surgical complications in lumbar discectomy via a posterior approach that occurred at our institution.
Case description: Case 1: a 57-year-old man underwent lumbar discectomy for a left L3-L4 herniated nucleus pulposus complicated by abdominal aortic and inferior mesenteric artery injury. Case 2: a 61-year-old male patient who underwent lumbar discectomy for a left L5-S1 herniated nucleus pulposus complicated by complete transection of the left ureter, injury to the left common iliac artery and vein, and formation of a traumatic arteriovenous fistula.
Surgery: Case 1: an exploratory laparotomy with vascular repair using an aortic prosthesis and delayed hemicolectomy was required. Case 2: vascular repair was performed using temporary clips and primary suture combined with primary ureteral repair and temporary nephrostomy.
Conclusion: vascular and urological injuries in lumbar spine surgery are serious complications with a low incidence and high morbidity and mortality if not identified early. A high index of suspicion and a multidisciplinary approach are required to adequately address these types of complications.
Downloads
References
1. Shriver MF, Xie JJ, Tye EY, Rosenbaum BP, Kshettry VR, Benzel EC, y col. Lumbar microdiscectomy complication rates: a systematic review and meta-analysis. Neurosurg Focus. 2015;39(4):E6. Doi: 10.3171/2015.7.FOCUS15281 DOI: https://doi.org/10.3171/2015.7.FOCUS15281
2. Bombieri FF, Shafafy R, Elsayed S. Complications associated with lumbar discectomy surgical techniques: a systematic review. J Spine Surg. 2022;8(3):377-89. Doi: 10.21037/jss-21-59 DOI: https://doi.org/10.21037/jss-21-59
3. Giotta Lucifero A, Gragnaniello C, Baldoncini M, Campero A, Savioli G, Tartaglia N, y col. Rating the incidence of iatrogenic vascular injuries in thoracic and lumbar spine surgery as regards the approach: A PRISMA-based literature review. Eur Spine J. 2021;30(11):3172-90. Doi: 10.1007/s00586-021-06956-4 DOI: https://doi.org/10.1007/s00586-021-06956-4
4. Denli Yalvac ES, Balak N. The probability of iatrogenic major vascular injury in lumbar discectomy. Br J Neurosurg. 2020;34(3):290-8. Doi: 10.1080/02688697.2020.1736261 DOI: https://doi.org/10.1080/02688697.2020.1736261
5. Turgut M, Turgut AT, Dogra VS. Iatrogenic ureteral injury as a complication of posterior or lateral lumbar spine surgery: A systematic review of the literature. World Neurosurg. 2020;135:280-96. Doi: 10.1016/j.wneu.2019.12.107 DOI: https://doi.org/10.1016/j.wneu.2019.12.107
6. Vaccaro AR, Kepler CK, Rihn JA, Suzuki H, Ratliff JK, Harrop JS, y col. Anatomical relationships of the anterior blood vessels to the lower lumbar intervertebral discs: analysis based on magnetic resonance imaging of patients in the prone position. J Bone Joint Surg Am. 2012;94(12):1088-94. Doi: 10.2106/JBJS.K.00671 DOI: https://doi.org/10.2106/JBJS.K.00671
7. Kot A, Polak J, Klepinowski T, Frączek MJ, Krzyżewski RM, Grochowska A, y col. Morphometric analysis of the lumbar vertebrae and intervertebral discs in relation to abdominal aorta: CT-based study. Surg Radiol Anat. 2022;44(3):431-41. Doi: 10.1007/s00276-021-02865-9 DOI: https://doi.org/10.1007/s00276-021-02865-9
8. Bulut S, Sakci Z, Naderi S. Illumination of the relationship between ureter and intervertebral disc by computed tomography. Turk Neurosurg. 2021;31(3):466-71. Doi: 10.5137/1019-5149.JTN.32650-20.4 DOI: https://doi.org/10.5137/1019-5149.JTN.32650-20.4
9. Liu B, Ye K, Gao S, Liu K, Feng H, Zhou F, y col. The summary of experience of abdominal vascular injury related to posterior lumbar surgery. Int Orthop. 2019;43(9):2191-8. Doi: 10.1007/s00264-018-4262-7 DOI: https://doi.org/10.1007/s00264-018-4262-7
10. Akhaddar A, Alaoui M, Turgut M, Hall W. Iatrogenic vascular laceration during posterior lumbar disc surgery: a literature review. Neurosurg Rev. 2021;44(2):821-42. Doi: 10.1007/s10143-020-01311-5 DOI: https://doi.org/10.1007/s10143-020-01311-5
11. Testa EJ, Alam SM, Kahan LG, Ziegler O, DeFroda S. Genitourinary complications in orthopaedic surgery. Orthop Traumatol. 2022;32(2):201-10. Doi: 10.1007/s00590-021-02944-y DOI: https://doi.org/10.1007/s00590-021-02944-y
12. Bozok S, Ilhan G, Destan B, Gokalp O, Gunes T. Approach to the vascular complications of lumbar disc surgery. Vascular. 2013;21(2):79-82. Doi: 10.1177/1708538113478727 DOI: https://doi.org/10.1177/1708538113478727
13. Abboudi H, Ahmed K, Royle J, Khan MS, Dasgupta P, N’Dow J. Ureteric injury: a challenging condition to diagnose and manage. Nat Rev Urol. 2013;10(2):108-15. Doi: 10.1038/nrurol.2012.254 DOI: https://doi.org/10.1038/nrurol.2012.254
14. van Zitteren M, Fan B, Lohle PN, de Nie JC, de Waal Malefijt J, Vriens PW, y col. A shift toward endovascular repair for vascular complications in lumbar disc surgery during the last decade. Ann Vasc Surg. 2013;27(6):810-9. Doi: 10.1016/j.avsg.2012.07.019 DOI: https://doi.org/10.1016/j.avsg.2012.07.019
