Skip to main content

Advertisement

SpringerLink
Log in

Iatrogenic vascular laceration during posterior lumbar disc surgery: a literature review

  • Review
  • Published:
Neurosurgical Review Aims and scope Submit manuscript

Abstract

Iatrogenic vascular laceration is a rare but well-known complication of posterior lumbar disc surgery (PLUDS). We performed a review of the literature to evaluate the management of this life-threatening complication. A total of 54 papers containing 100 cases of vascular laceration following PLUDS between 1969 and 2018 were analyzed with our representative case with a left common iliac artery (CIA) laceration during a posterior approach for a far lateral L4–L5 disc herniation. There were 54 females and 35 males (12 cases with unreported gender) with ages ranging from 20 to 72 years. The most commonly involved spinal level was L4–L5 (n = 67). The duration from the causative surgery to the symptom of the vascular injury ranged from 0 to 50 h (mean, 7.3 h). Only 47.3% of patients underwent postoperative imaging and the most commonly injured vessel was the CIA (n = 49). Vascular repair, open surgery, and/or an endovascular procedure was performed in 95 patients. The most frequent complications were deep venous thrombosis in the leg and pulmonary emboli, where a complete recovery was seen in 75.3% of patients. The mortality rate was 18.8%. In hemodynamically unstable cases, an emergent exploratory laparotomy was life-saving even without vascular imaging, although angiography with/without endovascular intervention may be used in stable patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Akhaddar A, Oukabli M, Albouzidi A et al (2011) Recurrent lumbosciatica because of cotton granuloma after surgery for lumbar disc herniation. Spine J 11:363–364. https://doi.org/10.1016/j.spinee.2011.03.002

    Article  PubMed  Google Scholar 

  2. Akhaddar A, Boucetta M (2012) Subconjunctival hemorrhage as a complication of intraoperative positioning for lumbar spinal surgery. Spine J 12:274. https://doi.org/10.1016/j.spinee.2012.02.007

    Article  PubMed  Google Scholar 

  3. Akhaddar A, Boulahroud O, Naama O, al-bouzidi A, Boucetta M (2012) Paraspinal textiloma after posterior lumbar surgery: a wolf in sheep’s clothing. World Neurosurg 77:375–380. https://doi.org/10.1016/j.wneu.2011.07.017

    Article  PubMed  Google Scholar 

  4. Akhaddar A (2017) Surgical site infections in spinal surgery. In: Akhaddar A (ed) Atlas of infections in neurosurgery and spinal surgery, 1st edn. Springer International Publishing, Switzerland, pp 217–228. https://doi.org/10.1007/978-3-319-60086-4_22

    Chapter  Google Scholar 

  5. Papadoulas S, Konstantinou D, Kourea HP, Kritikos N, Haftouras N, Tsolakis JA (2002) Vascular injury complicating lumbar disc surgery. A systematic review. Eur J Vasc Endovasc Surg 24:189–195

    Article  CAS  Google Scholar 

  6. Goodkin R, Laska LL (1998) Vascular and visceral injuries associated with lumbar disc surgery: medicolegal implications. Surg Neurol 49:358–370

    Article  CAS  Google Scholar 

  7. Ramirez LF, Thisted R (1989) Complications and demographic characteristics of patients undergoing lumbar discectomy in community hospitals. Neurosurgery 25:226–231

    Article  CAS  Google Scholar 

  8. Ewah B, Calder I (1991) Intraoperative death during lumbar discectomy. Br J Anaesth 66:721–723

    Article  CAS  Google Scholar 

  9. Moher D, Liberati A, Tetzlaff J, Altman DG (2009) Preferred reporting items for systematic reviews and meta-analyses; the PRISMA statement. J Clin Epidemiol 62:1006–1012

    Article  Google Scholar 

  10. Birkeland IW, Taylor TK (1969) Major vascular injuries in lumbar disc surgery. J Bone Joint Surg (Br) 51:4–19

    CAS  Google Scholar 

  11. Brewster DC, May AR, Darling RC et al (1979) Variable manifestations of vascular injury during lumbar disk surgery. Arch Surg 114:1026–1030

    Article  CAS  Google Scholar 

  12. Salander JM, Youkey JR, Rich NM et al (1984) Vascular injury related to lumbar disk surgery. J Trauma 24:628–631

    Article  CAS  Google Scholar 

  13. Kelly JJ, Reuter KL, Waite RJ (1989) Vascular injury complicating lumbar diskectomy: CT diagnosis. AJR Am J Roentgenol 153:1233–1234

    Article  CAS  Google Scholar 

  14. Villano M, Cantatore G, Narciso N, Santilli F, Bifano D, Cerillo A (1992) Vascular injury related to lumbar disk surgery. Neurochirurgia (Stuttg) 35:57–59

    CAS  Google Scholar 

  15. Raptis S, Quigley F, Barker S (1994) Vascular complications of elective lower lumbar disc surgery. Aust N Z J Surg 64:216–219

    Article  CAS  Google Scholar 

  16. Ezra E, Richenberg JL, Smellie WA (1996) Major vascular injury during lumbar laminectomy. J R Soc Med 89:108P–109P

    Article  CAS  Google Scholar 

  17. Fruhwirth J, Koch G, Amann W, Hauser H, Flaschka G (1996) Vascular complications of lumbar disc surgery. Acta Neurochir 138:912–916

    Article  CAS  Google Scholar 

  18. Kiev J, Dupont JR, Kerstein MD (1996) Injury of a medial sacral vessel during lumbar laminectomy. Ann Vasc Surg 10:63–65

    Article  CAS  Google Scholar 

  19. Szolar DH, Preidler KW, Steiner H, Riepl T, Flaschka G, Stiskal M, Moelleken S, Norman D (1996) Vascular complications in lumbar disk surgery: report of four cases. Neuroradiology 38:521–525

    Article  CAS  Google Scholar 

  20. Harrington JF Jr (2001) Far lateral disc excision at L5-S1 complicated by iliolumbar artery incursion: case report. Neurosurgery 48:1377–1379

    PubMed  Google Scholar 

  21. Tsai YD, Yu PC, Lee TC, Chen HS, Wang SH, Kuo YL (2001) Superior rectal artery injury following lumbar disc surgery. Case report. J Neurosurg 95:108–110

    CAS  PubMed  Google Scholar 

  22. Yu HP, Hseu SS, Sung CS et al (2001) Abdominal vascular injury during lumbar disc surgery. Zhonghua Yi Xue Za Zhi (Taipei) 64:649–654

    CAS  Google Scholar 

  23. Hui YL, Chung PC, Lau WM, Ng YT, Yu CC (2003) Vascular injury during a lumbar laminectomy. Chang Gung Med J 26:189–192

    PubMed  Google Scholar 

  24. Kwon TW, Sung KB, Cho YP, Kim DK, Ko GY, Yoon HK, Kim GE (2003) Large vessel injury following operation for a herniated lumbar disc. Ann Vasc Surg 17:438–444

    Article  Google Scholar 

  25. Bingol H, Cingoz F, Yilmaz AT, Yasar M, Tatar H (2004) Vascular complications related to lumbar disc surgery. J Neurosurg 100:249–253

    PubMed  Google Scholar 

  26. Ak H, Haluk I, Aysegul E et al (2006) Complications after lumbar discectomies: a medicolegal perspective from Turkey. Neurosurg Q 16:111–116

    Article  Google Scholar 

  27. Chang CP, Lee WS, Lee SC (2006) Left internal iliac artery and vein tear during microendoscopic lumbar discectomy - a case report. Minim Invasive Ther Allied Technol 15:155–158

    Article  Google Scholar 

  28. Döşoğlu M, Iş M, Pehlivan M et al (2006) Nightmare of lumbar disc surgery: iliac artery injury. Clin Neurol Neurosurg 108:174–177

    Article  Google Scholar 

  29. Raghuram M, Krishnan VR, Jaya Kumar D et al (2006) Common iliac injury following intervertebral discectomy. Indian J Surg 68:173

    Google Scholar 

  30. Erkut B, Unlü Y, Kaygin MA et al (2007) Iatrogenic vascular injury during to lumbar disc surgery. Acta Neurochir 149:511–515

    Article  CAS  Google Scholar 

  31. Jeon SH, Lee SH, Choi WC (2007) Iliac artery perforation following lumbar discectomy with microsurgical carbon dioxide laser: a report of a rare case and discussion on the treatment. Spine (Phila Pa 1976) 32:E124–E125

    Article  Google Scholar 

  32. Prabhakar H, Bithal PK, Dash M, Chaturvedi A (2005) Rupture of aorta and inferior vena cava during lumbar disc surgery. Acta Neurochir 147:327–329

    Article  CAS  Google Scholar 

  33. Torun F, Tuna H, Deda H (2007) Abdominal vascular injury during lumbar disc surgery: report of three cases. Ulus Travma Acil Cerrahi Derg 13:165–167

    PubMed  Google Scholar 

  34. Skippage P, Raja J, McFarland R et al (2008) Endovascular repair of iliac artery injury complicating lumbar disc surgery. Eur Spine J 17(Suppl 2):S228–S231

    Article  Google Scholar 

  35. Nam TK, Park SW, Shim HJ et al (2008) Endovascular treatment for common iliac artery injury complicating lumbar disc surgery: limited usefulness of temporary balloon occlusion. J Korean Neurosurg Soc 46:261–264

    Article  Google Scholar 

  36. Shih PY, Lau HP, Jeng CS, Hung MH, Chan KC, Cheng YJ (2009) Iatrogenic left internal iliac artery perforation during lumbar discectomy. Acta Anaesthesiol Taiwanica 47:196–199. https://doi.org/10.1016/S1875-4597(09)60054-0

    Article  Google Scholar 

  37. Karaikovic EE, Rattner Z, Bilimoria MM, Sener SF, McGee JP, Metrick LB, Szokol JW, Limthongkul W (2010) Coil embolization of a lumbar artery to control vascular injury during intradiscal surgery. Spine (Phila Pa 1976) 35:E163–E166

    Article  Google Scholar 

  38. Yi Y, Choi WJ, Kim YJ, Mok JM, Kim HS (2010) Rupture of external iliac artery during microscopic lumbar disc surgery -a case report. Korean J Anesthesiol 59(Suppl):S176–S178. https://doi.org/10.4097/kjae.2010.59.S.S176

    Article  PubMed  PubMed Central  Google Scholar 

  39. Canaud L, Hireche K, Joyeux F, D’Annoville T, Berthet JP, Marty-Ané C, Alric P (2011) Endovascular repair of aorto-iliac artery injuries after lumbar-spine surgery. Eur J Vasc Endovasc Surg 42:167–171. https://doi.org/10.1016/j.ejvs.2011.04.011

    Article  CAS  PubMed  Google Scholar 

  40. Madhusudan Reddy KR, Vimala S, Umamaheswara Rao GS (2011) Undetected iliac artery injury as acute intraoperative hypotension during lumbar disc surgery. Neurol India 59:307–308. https://doi.org/10.4103/0028-3886.79165

    Article  CAS  PubMed  Google Scholar 

  41. Yip SL, Woo SB, Kwok TK, Mak KH (2011) Nightmare of lumbar diskectomy: aorta laceration. Spine (Phila Pa 1976) 36:E1758–E1760. https://doi.org/10.1097/BRS.0b013e3182194e1c

    Article  Google Scholar 

  42. Jin SC, Park SW, Cho DS (2012) Management of proximal iliac artery injury during lumbar discectomy with stent graft. J Korean Neurosurg Soc 51:227–229. https://doi.org/10.3340/jkns.2012.51.4.227

    Article  PubMed  PubMed Central  Google Scholar 

  43. Liu Y (2012) Analysis of vascular injury in lumbar spine surgery. Pak J Med Sci 28:791–794

    CAS  Google Scholar 

  44. Başer A, Alkış O, Toktaş C et al (2016) A rare cause of ureteral injuries; simultaneous common iliac artery and ureter injury during posterior lumbar disc surgery. Turk J Urol 42:108–110. https://doi.org/10.5152/tud.2016.70105

    Article  PubMed  PubMed Central  Google Scholar 

  45. Bozok S, Ilhan G, Destan B, Gokalp O, Gunes T (2013) Approach to the vascular complications of lumbar disc surgery. Vascular 21:79–82. https://doi.org/10.1177/1708538113478727

    Article  PubMed  Google Scholar 

  46. Choi YS, Chung YS, Sim KB (2013) Subacute course of common iliac arterial laceration in lumbar disc surgery. J Korean Med Sci 28:167–169. https://doi.org/10.3346/jkms.2013.28.1.167

    Article  PubMed  PubMed Central  Google Scholar 

  47. Keskin M, Serin KR, Genc FA, Aksoy M, Yanar F, Kurtoglu M (2013) Iatrogenic major vascular injury during lumbar discectomy: report of three cases. Turk Neurosurg 23:385–388. https://doi.org/10.5137/1019-5149.JTN.4930-11.1

    Article  PubMed  Google Scholar 

  48. Olcay A, Keskin K, Eren F (2013) Iliac artery perforation and treatment during lumbar disc surgery by simple balloon tamponade. Eur Spine J 22(Suppl 3):S350–S352. https://doi.org/10.1007/s00586-012-2436-3

    Article  PubMed  Google Scholar 

  49. Postacchini R, Cinotti G, Postacchini F (2013) Injury to major abdominal vessels during posterior lumbar interbody fusion. A case report and review of the literature. Spine J 13:e7–e11. https://doi.org/10.1016/j.spinee.2012.11.016

    Article  PubMed  Google Scholar 

  50. Singh S, Bhanot A, Bajaj N, Rustagi P (2013) Innovative technique of vascular repair in intra-operative IVC rupture during lumbar microdiscectomy: a case report. Arch Trauma Res 2:133–135. https://doi.org/10.5812/atr.11005

    Article  PubMed  PubMed Central  Google Scholar 

  51. Yıldız R, Öztaş M, Şahin MA et al (2013) Abdominal aortic injury due to lumbar disc surgery: a case report. Ulus Cerrahi Derg 29:192–196. https://doi.org/10.5152/UCD.2013.33

    Article  PubMed  PubMed Central  Google Scholar 

  52. van Zitteren M, Fan B, Lohle PN, de Nie JC, de Waal Malefijt J, Vriens PW, Heyligers JM (2013) A shift toward endovascular repair for vascular complications in lumbar disc surgery during the last decade. Ann Vasc Surg 27:810–819. https://doi.org/10.1016/j.avsg.2012.07.019

    Article  PubMed  Google Scholar 

  53. Hafız E, Geyik M, Sarıçiçek V et al (2014) Aorta injury due to lomber hernia operation. JAEM 13:149–150

    Google Scholar 

  54. Leech M, Whitehouse MJ, Kontautaite R, Sharma M, Shanbhag S (2014) Abdominal aortocaval vascular injury following routine lumbar discectomy. Case Rep Anesthesiol 2014:1–3. https://doi.org/10.1155/2014/895973

    Article  Google Scholar 

  55. Busardò FP, Frati P, Carbone I, Pugnetti P, Fineschi V (2015) Iatrogenic left common iliac artery and vein perforation during lumbar discectomy: a fatal case. Forensic Sci Int 246:e7–e11. https://doi.org/10.1016/j.forsciint.2014.11.006

    Article  PubMed  Google Scholar 

  56. Vilariño Villaverde R, Bruguier C, Zerlauth JB, de Froidmont S, Grabherr S (2016) Tearing of the left iliac vessels in lumbar surgery revealed by multiphase post-mortem CT-angiography (MPMCTA). Leg Med (Tokyo) 20:44–48. https://doi.org/10.1016/j.legalmed.2016.04.003

    Article  Google Scholar 

  57. Jung HS, Kim DJ, Kim HS, Lee HK, Choi SJN, Chung SY (2017) Vascular complications related to posterior lumbar disc surgery. Vasc Specialist Int 33:160–165. https://doi.org/10.5758/vsi.2017.33.4.160

    Article  PubMed  PubMed Central  Google Scholar 

  58. Ventura F, Barranco R, Bernabei C, Castelletti L, Castellan L (2017) A fatal and unusual iatrogenic fourth right lumbar artery injury complicating wrong-level hemilaminectomy: a case report and literature review. Br J Neurosurg 7:1–3. https://doi.org/10.1080/02688697.2017.1351523

    Article  Google Scholar 

  59. Mishra B, Joshi MK, Gupta B, Farooque K (2018) Internal iliac artery transposition for vascular reconstruction in a patient with life-threatening iatrogenic common iliac artery injury. BMJ Case Rep. https://doi.org/10.1136/bcr-2016-219138

  60. Wang Y, Ai P, Zhan G et al (2018) Lumbar artery injury during transforaminal percutaneous endoscopic lumbar discectomy: successful treatment by emergent transcatheter arterial embolization. Ann Vasc Surg 53:267.e11–267.e14. https://doi.org/10.1016/j.avsg.2018.05.032

    Article  Google Scholar 

  61. El Idrissi R, Azghari A, Belmir H et al (2011) Vascular complications of lumbar disc herniation surgery: four cases. J Mal Vasc 36:126–127 [In French]

    Article  Google Scholar 

  62. Lrhezzioui J, Mansouri A, Kadiri B et al (2001) Iatrogenic wound of the hypogastric artery during lumbar disc surgery: about a case. Med Armées 29:15–17 [In French]

    Google Scholar 

  63. Stern SA, Dronen SC, Birrer P, Wang X (1993) Effect of blood pressure on hemorrhage volume and survival in near-fatal hemorrhage model incorporating a vascular injury. Ann Emerg Med 22:155–163

    Article  CAS  Google Scholar 

  64. Leppaniemi A, Soltero R, Burris D et al (1996) Fluid resuscitation in a model of uncontrolled hemorrhage: too much too early, or too little too late? J Surg Res 63:413–418

    Article  CAS  Google Scholar 

  65. Hildreth DH, Trucke DA (1977) Post laminectomy arteriovenous fistula. Surgery 81:512–520

    CAS  PubMed  Google Scholar 

  66. Assina R, Majmundar NJ, Herschman Y, Heary RF (2014) First report of major vascular injury due to lateral transpsoas approach leading to fatality. J Neurosurg Spine 21:794–798. https://doi.org/10.3171/2014.7.SPINE131146

    Article  PubMed  Google Scholar 

  67. Aichmair A, Fantini GA, Garvin S, Beckman J, Girardi FP (2015) Aortic perforation during lateral lumbar interbody fusion. J Spinal Disord Tech 28:71–75. https://doi.org/10.1097/BSD.0000000000000067

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

We thank the anonymous reviewers of the journal Neurosurgical Review for their constructive comments and help with the manuscript.

Author information

Authors and Affiliations

  1. Department of Neurosurgery, Avicenne Military Hospital of Marrakech, Mohammed V University, Rabat, Morocco

    Ali Akhaddar

  2. Department of Vascular Surgery, Avicenne Military Hospital of Marrakech, Cadi Ayyad University, Marrakech, Morocco

    Mustapha Alaoui

  3. Department of Neurosurgery, Aydın Adnan Menderes University Faculty of Medicine, Efeler, Aydın, Turkey

    Mehmet Turgut

  4. Department of Neurosurgery, State University of New York (SUNY), Upstate Medical University, Syracuse, NY, USA

    Walter Hall

Authors
  1. Ali Akhaddar
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Mustapha Alaoui
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Mehmet Turgut
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Walter Hall
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All authors contributed to the study conception and design. The first draft of the manuscript was written by the first author and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Mehmet Turgut.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Statement of human rights

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

Informed consent was obtained from the patient included in the case report.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Akhaddar, A., Alaoui, M., Turgut, M. et al. Iatrogenic vascular laceration during posterior lumbar disc surgery: a literature review. Neurosurg Rev 44, 821–842 (2021). https://doi.org/10.1007/s10143-020-01311-5

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10143-020-01311-5

Keywords

Search

Navigation