Coil embolization of a lumbar artery to control vascular injury during intradiscal surgery

Case study.

To emphasize the role that interventional radiology can perform in stemming bleeding to vascular structures injured during spine surgery without altering patient position.

Injury to the lumbar artery or aorta may occur during lumbar disc surgery. Occasionally the site of bleeding may not be readily identifiable or accessible through the surgical incision. Interventional radiology techniques may be employed to help locate and stop these difficult to locate vascular structures without changing a patient position.

A 48-year-old woman undergoing L4-L5 lumbar hemilaminectomy and discectomy secondary to a herniated disc sustained an injury to a right L3 lumbar artery. Several liters of blood were lost in an attempt to surgically locate and repair the injury to the lumbar artery. A literature search identified the potential severity and treatment options.

An interventional radiologist was called for and he was able to angiographically locate the source of bleeding and stem its source using coil embolization of the lumbar artery.

Whenever there is bleeding from an inaccessible site, consultation with an interventional radiologist to perform an intraoperative coil embolization of the injured vessel should be done especially if a resort to an anterior abdominal approach would permit uncontrolled bleeding.