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. ClarkEmail author
Case Report



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.


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


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.


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.


Vascular injury Minimally invasive Lateral interbody fusion Ankylosing spondylitis 


Compliance with ethical standards

Conflict of interest

None of the authors has any potential conflict of interest.


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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

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