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Major vessel injury with cage migration: surgical complication in a case of spondylodiscitis
Uday M Pawar1, Vishal Kundnani, Abhay Nene
1Department of Orthopedics, P. D. Hinduja National Hospital and Research Centre, Mahim, Mumbai, Maharashtra, India. umporthodoc@yahoo.com
Study Design:
Case report.
Objective:
To report the unique nature of a technique-related complication with major vessel injury in case of lumbar spondylodiscitis.
Summary Of Background Data:
Perioperative major vessel injuries during spinal surgeries are uncommon but are reported complications. The unusual nature of the complication and its prognostic dilemma is the purpose of this case report.
Methods:
A 55-year-old woman presented with infective L3-L4 spondylodiscitis and was offered transforaminal lumbar interbody fusion surgery. Intraoperative manipulation to attain optimum cage position resulted in its dislodgement anteriorly and vessel injury with torrential hemorrhage, which was successfully managed surgically without mortality.
Results:
On thorough investigation in the postoperative period, the cage was found to have migrated to the left pulmonary artery. The patient recovered completely of her preoperative status and is asymptomatic 6 months after surgery.
Conclusion:
The presented complication is a catastrophe considering a routine surgical procedure. In cases of spondylodiscitis, spine surgeons should be careful about inflammation of major vessels with friable vessel walls anterior to the vertebrae. This mandates a cautious surgical technique.
