Injuries to the large abdominal vessels during lumbar nucleotomy

The rare complication of iatrogenic damage to the large abdominal blood vessels during lumbar intervertebral disc operations is demonstrated by three case reports. A sudden decrease in blood pressure and tachycardia are major signs of such vessel lacerations. Due to a valve mechanism which prevents a dorsal blood leakage through the intervertebral space, early detection of this problem by the surgeon or anesthesiologist may prove to be difficult. Myocardial infarction, pulmonary embolism, abnormal volume distribution after positioning, dysfunction of circulatory regulation due to anesthesia or faulty positioning, obstruction of the subclavian artery due to false placement of chest padding, all occur more frequently and therefore must be considered and excluded. A wrong interpretation of this acute occurrence carries a mortality of 70%. Even immediate intervention by vascular surgery shows a mortality rate of 50% for this uncommon emergency. In order to prevent the disastrous sequelae to this complication, blood vessel injury should be suspected for every unexplained intraoperative decrease in blood pressure during lumbar nucleotomy. Only a rapid termination of the operation and appropriate preparation for vascular surgery can lower the mortality of this rare occurrence.