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Vascular and visceral injuries associated with lumbar disc surgery: medicolegal implications
1Department of Neurological Surgery, University of Washington School of Medicine and VA Puget Sound Health Care System, Seattle 98195, USA.
Insights
Perforation of the anterior annulus fibrosus/anterior longitudinal ligament during lumbar disc surgery can cause severe intra-abdominal injuries. This complication, though potentially fatal, may be underreported and carries significant medicolegal consequences.
Area of Science:
- Neurosurgery
- Orthopedic Surgery
- Spinal Surgery
Background:
- Herniated lumbar disc disease necessitates surgical intervention, carrying inherent risks.
- Complications during spinal surgery require thorough investigation and understanding.
Observation:
- Symptomatic perforation of the anterior annulus fibrosus/anterior longitudinal ligament is a rare but serious surgical complication.
- This injury can lead to intra-abdominal vessel or viscera damage, with potentially fatal outcomes.
Findings:
- The authors documented 21 cases of intra-abdominal injury resulting from anterior annulus fibrosus/anterior longitudinal ligament perforation since 1985.
- All reported cases led to litigation, with settlements or verdicts rendered.
Implications:
- The actual incidence of this complication may be higher than currently recognized in the medical community.
- Understanding the medicolegal ramifications is crucial for surgeons performing lumbar disc surgery.
- This highlights the importance of meticulous surgical technique and awareness of potential ventral perforations.
Abstract:
Symptomatic perforation of the anterior annulus fibrosus/anterior longitudinal ligament during surgery for herniated lumbar disc disease is one of the more solemn and sobering complications experienced by neurosurgeons or orthopedic surgeons. This complication frequently results in the death of the patient. Its occurrence is probably more common than the medical community would expect. The authors report 21 cases since 1985 in which an injury to an intra-abdominal vessel or viscera occurred. In all cases litigation resulted and a settlement or verdict was rendered. A review of the literature is presented and the medicolegal implications of symptomatic ventral perforations of the annulus fibrosus/anterior longitudinal ligament are discussed.