Abstract
Full-endoscopic transforaminal lumbar discectomy is based on a puncture technique using a guide needle to reach the target area of the foramen via a percutaneous posterolateral/lateral approach. It may correlate with specific approach-related complications, as exiting nerve root injury. We report the first case of pseudoaneurysm of the lumbar segmental artery secondary to a transforaminal full-endoscopic surgery in the treatment of a lumbar herniated disc. A 39-year-old man underwent left L4-L5 full-endoscopic transforaminal lumbar discectomy for a herniated disc. Three hours after surgery, he experienced acute progressive abdominal pain. An abdomen CT scan showed contrast extravasation in the left paraspinal compartment at L4 vertebral body level. The selective left lumbar angiogram revealed a pseudoaneurysm of a side branch of the left lumbar segmental artery, which was treated by endovascular coiling. The patient made a rapid postoperative recovery without further complications and was discharged 4 days later. This report identifies a rare complication of transforaminal full-endoscopic surgery in the treatment of a herniated lumbar disc. To our knowledge this is the first case of pseudoaneurysm formation of the lumbar artery following a full-endoscopic transforaminal lumbar discectomy.
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Full-endoscopic procedures are advocated for their minimal invasive nature and most proponents claim complication rates close to zero. While potential advantages like less scaring have not yet been properly evaluated, others have attributed problems like approach-related neuropathic pain to the transforaminal endoscopic route.
This interesting case report adds to the discussion of the pros and cons of full-endoscopic disc surgery in comparison with microscopic procedures reminding us of the difference in possible severe complications of lateral endoscopic procedures with blind access to the site of action.
Claudius Thomé
Innsbruck, Austria
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Panagiotopoulos, K., Gazzeri, R., Bruni, A. et al. Pseudoaneurysm of a segmental lumbar artery following a full-endoscopic transforaminal lumbar discectomy: a rare approach-related complication. Acta Neurochir 161, 907–910 (2019). https://doi.org/10.1007/s00701-019-03876-7
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DOI: https://doi.org/10.1007/s00701-019-03876-7