Vascular iatrogenic injury during lumbar disc surgery: a literature review

Vascular injury during lumbar disc surgery was first reported as a complication in 1945 by Linton and White [32]. Injuries of the major blood vessels located anteriorly to the spine in the retroperitoneal space are rare but occur suddenly and are life-threatening. The authors present anatomo-topographical background of this complication, standards of diagnostic process and treatment on the base of literature as well the surgical and endovascular management of this complication. The authors performed a literature search for reported iatrogenic vascular injuries due to lumbar disc surgery. We were able to find 10 case series and 17 single case reports describing this rare but serious lumbar disc surgeryrelated complication. Overall, there were 159 patients who developed vascular injury due to lumbar disc surgery. The surgical exploration and repair has been done in 116 patients. In last decades due to rapid development of endovascular techniques this complication was repaired endovascular techniques in 21 patients. The most common lumbar level which resulted in iatrogenic vascular injury was L4-L5. There were reported 66 deaths and in 83 patients the postoperative period was uneventful.

We would like to highlight the occurrence of this complication and introduction of rapid management to prevent the fatal outcome. Lumbar disc surgery is one of the most often performed procedures in neurosurgical wards. The awareness of this life-threatening complication should be known to all members of an operative team. The knowledge of proper management of this serious adverse event may save a patient's life.