Aortic perforation during lateral lumbar interbody fusion

Area of Science:

• Spine surgery
• Minimally invasive procedures
• Vascular complications

Background:

• Lateral lumbar interbody fusion (LLIF) is a minimally invasive transpsoas approach to the lumbar spine.
• LLIF aims to avoid anterior intraperitoneal complications like visceral and vascular injuries.
• Potential risks associated with LLIF are still being identified.

Observation:

• A unique case of aortic perforation during LLIF is presented.
• The complication occurred secondary to an incidental endplate and anterior vertebral cortex violation.
• Aortic injury was associated with implant breakage and cage misplacement during L3-L4 fusion.

Findings:

• Intraoperative aortic perforation was diagnosed following immediate blood pressure drop.
• Emergency laparotomy revealed a through-and-through laceration of the aortic terminus.
• Successful suture repair of the aorta was performed, and the patient stabilized.

Implications:

• Endplate and anterior cortex violation during LLIF can create bony spurs near major abdominal vessels.
• Vascular injury, including aortic perforation, can occur despite the avoidance of an anterior surgical approach.
• This rare complication necessitates prompt recognition and emergency surgical intervention.