Vascular complications in lumbar disk surgery : report of four cases

• Published in: Neuroradiology Vol. 38; no. 6; pp. 521 - 525
• Main Authors: SZOLAR, D. H, PREIDLER, K. W, STEINER, H, RIEPL, T, FLASCHKA, G, STISKAL, M, MOELLEKEN, S, NORMAN, D
• Format: Journal Article
• Language: English
• Published: Berlin Springer 01-08-1996
• Subjects: Aged; Angiography; Aorta, Abdominal - injuries; Aorta, Abdominal - pathology; Aortic Aneurysm, Abdominal - diagnosis; Aortic Aneurysm, Abdominal - surgery; Arteries - injuries; Arteriovenous Fistula - diagnosis; Arteriovenous Fistula - surgery; Biological and medical sciences; Diagnostic Imaging; Diskectomy; Female; Follow-Up Studies; Humans; Iliac Artery - injuries; Iliac Artery - pathology; Iliac Vein - injuries; Iliac Vein - pathology; Intervertebral Disc Displacement - surgery; Intraoperative Complications - diagnosis; Intraoperative Complications - surgery; Lumbar Vertebrae - blood supply; Lumbar Vertebrae - surgery; Male; Medical sciences; Middle Aged; Orthopedic surgery; Postoperative Complications - diagnosis; Postoperative Complications - surgery; Sacrum - blood supply; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Vena Cava, Inferior - injuries; Vena Cava, Inferior - pathology; Human; Iatrogenic; Radiodiagnosis; Angiography; Lumbar spine; Diseases of the osteoarticular system; Cardiovascular disease; Spine disease; Nuclear magnetic resonance imaging; Retrospective; Hernia; Vascular disease; Surgery; Complication; Computerized axial tomography; Intervertebral disk
• ISSN: 0028-3940; 1432-1920
• DOI: 10.1007/bf00626086

Vascular injuries in lumbar disk surgery, although rare, are serious complications which may be overlooked due to a broad range of clinical manifestations. It is important that surgeons and radiologists be aware of these potentially fatal complications and develop an appropriate symptom-based diagnostic paradigm. We reviewed 8099 consecutive cases of lumbar disk surgery, performed over a 14-year period at a single institution, for postoperative vascular complications. We identified four patients (0.05%) with lumbar disk surgery-related vascular complications: intraoperative lacerations of the abdominal aorta and median sacral artery, an arteriovenous fistula between the left common iliac artery and vein detected 19 days postdiskectomy, and a partially thrombosed aortic aneurysm with an arteriovenous fistula between the aneurysm and the inferior vena cava, diagnosed 11 months after surgery. The majority of cases in the literature of vascular injury in lumbar disk surgery were reported prior to 1965. Diagnostic approaches described in that period do not reflect the great range of diagnostic techniques available today. Angiography remains the gold standard for diagnosis and guidance as to surgical repair. However, a high index of suspicion based on clinical signs and/or the use of sonography or CT is important in the detection of these complications.