Advertisement

European Spine Journal

, Volume 27, Supplement 3, pp 538–543 | Cite as

Management of aortic injury during minimally invasive lateral lumbar interbody fusion

  • Michael M. Safaee
  • Devin Zarkowsky
  • Charles M. Eichler
  • Murat Pekmezci
  • Aaron J. Clark
Case Report

Abstract

Purpose

Minimally invasive lateral approaches to the lumbar spine allow for interbody fusion with good visualization of the disk space, minimal blood loss, and decreased length of stay. Major neurologic, vascular, and visceral complications are rare with this approach; however, the steps in management for severe vascular injuries are not well defined. We present a case report of aortic injury during lateral interbody fusion and discuss the use of endovascular repair.

Methods

This study is a case report of an intraoperative aortic injury.

Results

A 59-year-old male with ankylosing spondylitis suffered an acute L1 Chance fracture after mechanical fall. He was taken to the operating room for a T10–L4 posterior instrumented fusion followed by a minimally invasive L1–L2 lateral interbody fusion for anterior column support. During the discectomy, brisk arterial bleeding was encountered due to an aortic injury. The vascular surgery team expanded the incision in an attempt to control the bleeding but with limited success. The patient underwent intraoperative angiogram with placement of stent grafts at the level of the injury followed by completion of the interbody fusion. Despite the potentially catastrophic nature of this injury, the patient made a good recovery and was discharged home in stable condition with no new neurologic deficits.

Conclusions

This case highlights the importance of immediate recognition and imaging of any potential vascular injury during minimally invasive lateral interbody fusion. Given the poor outcomes associated with attempted open repair, endovascular techniques provide a valuable tool for the treatment of these complex injuries with significantly less morbidity.

Keywords

Vascular injury Minimally invasive Lateral interbody fusion Ankylosing spondylitis 

Notes

Compliance with ethical standards

Conflict of interest

None of the authors has any potential conflict of interest.

References

  1. 1.
    Dakwar E, Cardona RF, Smith DA, Uribe JS (2010) Early outcomes and safety of the minimally invasive, lateral retroperitoneal transpsoas approach for adult degenerative scoliosis. Neurosurg Focus 28:E8.  https://doi.org/10.3171/2010.1.FOCUS09282 CrossRefPubMedGoogle Scholar
  2. 2.
    Deluzio KJ, Lucio JC, Rodgers WB (2010) Value and cost in less invasive spinal fusion surgery: lessons from a community hospital. SAS J 4:37–40.  https://doi.org/10.1016/j.esas.2010.03.004 CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Ozgur BM, Aryan HE, Pimenta L, Taylor WR (2006) Extreme Lateral Interbody Fusion (XLIF): a novel surgical technique for anterior lumbar interbody fusion. Spine J 6:435–443.  https://doi.org/10.1016/j.spinee.2005.08.012 CrossRefPubMedGoogle Scholar
  4. 4.
    Fujibayashi S, Kawakami N, Asazuma T, Ito M, Mizutani J, Nagashima H, Nakamura M, Sairyo K, Takemasa R, Iwasaki M (2017) Complications associated with lateral interbody fusion: nationwide survey of 2998 cases during the first two years of its use in Japan. Spine (Phila Pa 1976).  https://doi.org/10.1097/brs.0000000000002139
  5. 5.
    Rodgers WB, Gerber EJ, Patterson J (2011) Intraoperative and early postoperative complications in extreme lateral interbody fusion: an analysis of 600 cases. Spine (Phila Pa 1976) 36:26–32.  https://doi.org/10.1097/brs.0b013e3181e1040a CrossRefGoogle Scholar
  6. 6.
    Uribe JS, Deukmedjian AR (2015) Visceral, vascular, and wound complications following over 13,000 lateral interbody fusions: a survey study and literature review. Eur Spine J 24(Suppl 3):386–396.  https://doi.org/10.1007/s00586-015-3806-4 CrossRefPubMedGoogle Scholar
  7. 7.
    Rustagi T, Drazin D, Oner C, York J, Schroeder GD, Vaccaro AR, Oskouian RJ, Chapman JR (2017) Fractures in spinal ankylosing disorders: a narrative review of disease and injury types, treatment techniques, and outcomes. J Orthop Trauma 31(Suppl 4):S57–S74.  https://doi.org/10.1097/BOT.0000000000000953 CrossRefPubMedGoogle Scholar
  8. 8.
    Tohmeh AG, Rodgers WB, Peterson MD (2011) Dynamically evoked, discrete-threshold electromyography in the extreme lateral interbody fusion approach. J Neurosurg Spine 14:31–37.  https://doi.org/10.3171/2010.9.SPINE09871 CrossRefPubMedGoogle Scholar
  9. 9.
    Uribe JS, Vale FL, Dakwar E (2010) Electromyographic monitoring and its anatomical implications in minimally invasive spine surgery. Spine (Phila Pa 1976) 35:368–374.  https://doi.org/10.1097/brs.0b013e3182027976 CrossRefGoogle Scholar
  10. 10.
    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 CrossRefPubMedGoogle Scholar
  11. 11.
    Santillan A, Patsalides A, Gobin YP (2010) Endovascular embolization of iatrogenic lumbar artery pseudoaneurysm following extreme lateral interbody fusion (XLIF). Vasc Endovascular Surg 44:601–603.  https://doi.org/10.1177/1538574410374655 CrossRefPubMedGoogle Scholar
  12. 12.
    Peiro-Garcia A, Dominguez-Esteban I, Alia-Benitez J (2016) Retroperitoneal hematoma after using the extreme lateral interbody fusion (XLIF) approach: presentation of a case and a review of the literature. Rev Esp Cir Ortop Traumatol 60:330–334.  https://doi.org/10.1016/j.recot.2014.12.006 PubMedCrossRefGoogle Scholar
  13. 13.
    Hu WK, He SS, Zhang SC, Liu YB, Li M, Hou TS, Ma XL, Wang J (2011) An MRI study of psoas major and abdominal large vessels with respect to the X/DLIF approach. Eur Spine J 20:557–562.  https://doi.org/10.1007/s00586-010-1609-1 CrossRefPubMedGoogle Scholar
  14. 14.
    Regev GJ, Chen L, Dhawan M, Lee YP, Garfin SR, Kim CW (2009) Morphometric analysis of the ventral nerve roots and retroperitoneal vessels with respect to the minimally invasive lateral approach in normal and deformed spines. Spine (Phila Pa 1976) 34:1330–1335.  https://doi.org/10.1097/brs.0b013e3181a029e1 CrossRefGoogle Scholar
  15. 15.
    Uribe JS, Arredondo N, Dakwar E, Vale FL (2010) Defining the safe working zones using the minimally invasive lateral retroperitoneal transpsoas approach: an anatomical study. J Neurosurg Spine 13:260–266.  https://doi.org/10.3171/2010.3.SPINE09766 CrossRefPubMedGoogle Scholar
  16. 16.
    Kose KC, Bozduman O, Yenigul AE, Igrek S (2017) Spinal osteotomies: indications, limits and pitfalls. EFORT Open Rev 2:73–82.  https://doi.org/10.1302/2058-5241.2.160069 CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Westerveld LA, van Bemmel JC, Dhert WJ, Oner FC, Verlaan JJ (2014) Clinical outcome after traumatic spinal fractures in patients with ankylosing spinal disorders compared with control patients. Spine J 14:729–740.  https://doi.org/10.1016/j.spinee.2013.06.038 CrossRefPubMedGoogle Scholar
  18. 18.
    Finkelstein JA, Chapman JR, Mirza S (1999) Occult vertebral fractures in ankylosing spondylitis. Spinal Cord 37:444–447CrossRefPubMedGoogle Scholar
  19. 19.
    Werner BC, Samartzis D, Shen FH (2016) Spinal fractures in patients with ankylosing spondylitis: etiology, diagnosis, and management. J Am Acad Orthop Surg 24:241–249.  https://doi.org/10.5435/JAAOS-D-14-00149 CrossRefPubMedGoogle Scholar
  20. 20.
    Hunter T, Forster B, Dvorak M (1995) Ankylosed spines are prone to fracture. Can Fam Physician 41:1213–1216PubMedPubMedCentralGoogle Scholar
  21. 21.
    Carnell J, Fahimi J, Wills CP (2009) Cervical spine fracture in ankylosing spondylitis. West J Emerg Med 10:267CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Einsiedel T, Schmelz A, Arand M, Wilke HJ, Gebhard F, Hartwig E, Kramer M, Neugebauer R, Kinzl L, Schultheiss M (2006) Injuries of the cervical spine in patients with ankylosing spondylitis: experience at two trauma centers. J Neurosurg Spine 5:33–45.  https://doi.org/10.3171/spi.2006.5.1.33 CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Neurological SurgeryUniversity of California, San FranciscoSan FranciscoUSA
  2. 2.Division of Vascular and Endovascular Surgery, Department of General SurgeryUniversity of California, San FranciscoSan FranciscoUSA
  3. 3.Department of Orthopedic SurgeryUniversity of California, San FranciscoSan FranciscoUSA

Personalised recommendations