Conservative Management of Ureteral Injury Caused by a Lumbar Osteophyte

Osteophytes are bony outgrowths commonly found on lumbar vertebrae. They rarely produce complications with the most common complication being nerve entrapment, but rarer complications including aorta or inferior vena cava rupture, superior mesenteric artery syndrome, compression of the iliopsoas muscle, and cerebrospinal fluid leaks have been described. Rare cases affecting the ureter resulting in ureteral colic or extravasation of urine have been described. We describe a case in which a lumbar osteophyte bridging the L4 and L5 disks was encircling the ureter and minor trauma caused a ureteral injury, resulting in urine extravasation into the L4 and L5 disks space and the retroperitoneum. Owing to the comorbidities of this patient, this case was treated conservatively with stenting and the patient has suffered no further complications. This is a rare complication of a lumbar osteophyte but should be considered as a potential cause of ureter injury. Treatment should be individualized by patient preference and comorbidities, as some patients would elect to pursue more aggressive therapy whereas others would incline for conservative measures.