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Vascular Complications Related to Posterior Lumbar Disc Surgery
Hong Sung Jung1, Dae Jung Kim1, Hyo Shin Kim1
1Department of Surgery, Chonnam National University Hospital, Gwangju, Korea.
Insights
Vascular injuries from posterior lumbar disc surgery can be fatal but are rare. Prompt diagnosis and treatment, including surgical or endovascular methods, are crucial for successful outcomes.
Area of Science:
- Vascular Surgery
- Neurosurgery
- Interventional Radiology
Background:
- Vascular injury is a rare but serious complication of posterior lumbar disc surgery.
- Timely recognition and management are critical to prevent severe morbidity and mortality.
Purpose of the Study:
- To evaluate treatment strategies and outcomes for patients experiencing vascular injury following posterior lumbar disc surgery.
Main Methods:
- Retrospective review of seven cases (1997-2016) involving vascular injuries (lacerations, arteriovenous fistula, pseudoaneurysms) related to posterior lumbar disc surgery.
- Analysis of patient demographics, injury types, diagnostic methods, treatment approaches (surgical vs. endovascular), and clinical outcomes.
Main Results:
- Five of seven cases occurred during hospitalization; three presented with life-threatening lacerations requiring immediate surgical repair.
- Endovascular interventions were used for pseudoaneurysms and arteriovenous fistulas.
- No treatment-related deaths or long-term sequelae were observed.
Conclusions:
- Vascular injury after posterior lumbar disc surgery, though uncommon, necessitates early detection and prompt intervention.
- Endovascular treatment is increasingly preferred for stable patients due to lower morbidity.
- Surgical repair remains the primary option for hemodynamically unstable patients.
Purpose:
To evaluate patients who underwent surgical or endovascular treatment after vascular injury related to posterior lumbar disc surgery.
Materials And Methods:
We retrospectively reviewed seven cases of vascular injuries (four lacerations, one arteriovenous fistula [AVF], and two pseudoaneurysms) related to lumbar disc surgery by a posterior approach from January 1997 to December 2016 at Chonnam National University Hospital. Information of patient characteristics, diagnosis, treatment strategies, and outcomes were analyzed.
Results:
Five out of seven cases were inhospital cases. In three laceration cases, each patient instantly became hypotensive and a life-threatening arterial injury was suspected. Therefore, the patient was immediately turned to the supine position and surgical repair was performed. The patients with pseudoaneurysm and AVF were treated by endovascular intervention. Remaining two were referred cases under the impression of vascular injuries. One laceration case of them was in preshock condition, and the left common iliac artery was surgically repaired. The other referred patient showed pseudoaneurysm which was treated with stent graft insertion. There was no surgery or endovascular intervention related death and none of the patients suffered any sequela related to vascular injury.
Conclusion:
Vascular injury associated with posterior lumbar disc surgery is not common, but can be fatal. Early recognition, diagnosis, and prompt treatment are essential to prevent fatal outcomes. Recently, endovascular intervention is increasingly and preferably used because of its low morbidity and mortality. However surgery is still the best option for the patients with unstable vital sign and endovascular approach can be applied to stable patients.
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