Abdominal vascular injury during lumbar disc surgery

Major vascular injury is an unusual but well-recognized complication of vertebral disc surgery. Isolated arterial laceration is the most common type of this vessel injury in lumbar spine surgery, with early manifestation due to retroperitoneal hemorrhage. Two cases are described that illustrate the full spectrum of acute manifestation of such injuries. Two cases of acute hemorrhage due to arterial trauma were seen; one mortality case was recognized during the operation and one salvaged in the recovery room. In both cases unstable perioperative hemodynamics and postoperative distended abdomen were observed. It is the purpose of this paper to report two cases and to discuss the morbid anatomy, diagnosis of such vascular injuries and anesthetic handling of retroperitoneal hemorrhage. For anesthesiologists who are also drill workers while doing lumbar spinal or epidural anesthesia, these rare catastrophes remind us to pay special attention to the vertebral vascular (not only skeletal) anatomy.