[Ureteral injury after posterior lumbar surgery. Case report]

The percentage of complications in posterior lumbar spine surgery varies from 1,9 to 10,8%. Injury to retroperitoneal structures is a severe but unfrequent complication. Ureter injury is an extremely rare complication with only 24 documented cases up to date.

43 year old woman. A deep bleeding was observed while performing a L4-L5 microdiscectomy. It was controlled with firm pressure and hemostatic agents. 36 hours later the patient developed a distended and painful abdomen associated with anemia and an increase in white blood cell count. Abdominal CT and retrograde pyelography confirmed the diagnosis of ureter injury. An emergency laparotomy was perfomed and a total section of the left ureter was treated with a end to end anastomosis.

Ureter injury in posterior lumbar spine surgery can happen due to its close anatomical relationship with the vertebral body and disc. L4-L5 is the level most often affected. Due to the fact the ureter is surrounded by retroperitoneal fat, injury is less likely to happen and thus the low number of documented cases. Although the initial symptomatology may be inespecific, an early diagnosis is essential in order to avoid further complications such as a sepsis or a kidney loss. There are several treatment options although the most often used is the end to end anastomosis specially if there is a complete ureter injury.