Management of major vascular injury during pedicle screw instrumentation of thoracolumbar spine

Mirza, Aleem K.; Alvi, Mohammed Ali; Naylor, Ryan M.; Kerezoudis, Panagiotis; Krauss, William E.; Clarke, Michelle J.; Shepherd, Daniel; Nassr, Ahmad; DeMartino, Randall R.; Bydon, Mohamad

doi:10.1016/j.clineuro.2017.10.011

Cited by 21 publications

(14 citation statements)

References 20 publications

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“…The rapid development of endovascular techniques in the last decade is changing the treatment of vascular injuries in general. With the latest improvements in stent technology, covered stent graft placement for traumatic lacerations 10 (PA and AVF) is the preferred endovascular technique 11, 12. However, this technique needs an adequate morphology, which was not the case for this patient, who had a complete arterial and venous avulsion.…”

Section: Discussionmentioning

confidence: 98%

Complete Disruption of The Iliac Vessels During Spinal Surgery With Delayed Presentation

Moutinho

Silvestre

Belo

et al. 2019

EJVES Short Reports

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Introduction The posterior approach to the lumbar spine is most commonly used to treat lumbar spine pathology. Vascular complications, although rare, have a high mortality rate. This is the report of an arterial lesion complicating a L5 hemilaminectomy and its surgical resolution. The need to remain vigilant for this condition, which requires prompt diagnosis and treatment, is emphasised. Report A 31 year old woman was admitted to the neurosurgery department with L5 right-sided sciatica and an associated radiculopathy, and paraesthesia of the first toe of the right foot. She had previously undergone surgical correction of a L4 – L5 lumbar disc herniation, as well as a left oophorectomy and chemotherapy for ovarian neoplasia. A right L5 hemilaminectomy associated with right L5 – S1 foraminotomy and L5 – S1 discectomy was performed with the patient in the ventral position. The procedure was carried out without any apparent complications. In the first three post-operative days the patient complained persistently of orthostatic hypotension and a drop in haemoglobin was observed. Computed tomography angiography revealed what appeared to be a complete transection of the right common iliac artery and vein, with active haemorrhage, and a large pseudoaneurysm. Immediate surgery was carried out with reconstruction consisting of a 9 mm Dacron graft interposed in the right common iliac artery, as well as ligation of the right common iliac vein, which was not amenable to repair. The post-operative period was uneventful. The patient was discharged on day 13 with normal lower limb pulses and mild oedema of the right lower limb, controlled with elastic compression stockings. Discussion Iatrogenic injuries of the large abdominal vessels during spinal surgery is rare but serious. Close patient surveillance and remaining vigilant for these life threatening vascular lesions are crucial in the peri-operative period of spinal surgery.

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Section: Discussionmentioning

confidence: 98%

Complete Disruption of The Iliac Vessels During Spinal Surgery With Delayed Presentation

Moutinho

Silvestre

Belo

et al. 2019

EJVES Short Reports

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“…Vascular complications can be divided into those detected intraoperatively, early (a few hours after surgery), or late (after a few months). 5,6 Lumbar arteries are small branches of the abdominal aorta, iliac lumbar artery, or medial artery, which has a diameter of up to 2.9 mm. 8 Only a few cases of iatrogenic lumbar injury have been reported and most of them have a rapid course with hemodynamic shock.…”

Section: Discussionmentioning

confidence: 99%

“…In the last few years, to reduce intraoperative X-ray radiation, many spine surgeons are returning to the free-hand screw insertion technique, using anatomical points. 2–4 Vascular complications of spinal surgery are rare, with the incidence ranging from 0.01% to 0.22% 5,6 and the mortality rate ranging from 15% to 65%. 6 The most commonly damaged vessels are the aorta, the common iliac vein, and the internal iliac vein.…”

Section: Introductionmentioning

confidence: 99%

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Iatrogenic lumbar artery pseudoaneurysm after lumbar transpedicular fixation: Case report

Zurawel

Maj

Olbrycht

et al. 2019

SAGE Open Medical Case Reports

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Only a few cases of iatrogenic lumbar injury have been reported in the literature. A 58-year-old male with severe back pain was admitted to our department. The patient was qualified for the transpedicular stabilization with interbody fixation at L4/L5 and L5/S1 levels. On the first day after surgery, the patient was mobile and reported significant pain relief. He was discharged the same day. After 2 weeks, the patient returned with severe right lower abdominal pain and radicular pain in his right leg. He was administered to the Neurology Department where the presence of a lumbar muscle hematoma and lumbar artery pseudoaneurysm were discovered. He was transferred to the Vascular Surgery Department where aortography was performed and the pseudoaneurysm was embolized. After few days, the patient’s overall condition improved significantly. Eight weeks after surgery, he was pain-free. Our case shows how initially innocuous symptoms may be the result of serious complications.

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“…They are characterized by a widening of the arterial pressure and tachycardia, which are possibly related formation of thrombi, pseudoaneurysms, or arteriovenous fistulas [12][13][14][15][16]. One difficulty to recognize the cause of delayed vascular injury relates to progressive damage to the vessel wall by prominent hardware [17][18][19][20][21].…”

Section: Introductionmentioning

confidence: 99%

Rating the incidence of iatrogenic vascular injuries in thoracic and lumbar spine surgery as regards the approach: A PRISMA-based literature review

et al. 2021

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Purpose To assess the rate, timing of diagnosis, and repairing strategies of vascular injuries in thoracic and lumbar spine surgery as their relationship to the approach. Methods PubMed, Medline, and Embase databases were utilized for a comprehensive literature search based on keywords and mesh terms to find articles reporting iatrogenic vascular injury during thoracic and lumbar spine surgery. English articles published in the last ten years were selected. The search was refined based on best match and relevance. Results Fifty-six articles were eligible, for a cumulative volume of 261 lesions. Vascular injuries occurred in 82% of instrumented procedures and in 59% during anterior approaches. The common iliac vein (CIV) was the most involved vessel, injured in 49% of anterior lumbar approaches. Common iliac artery, CIV, and aorta were affected in 40%, 28%, and 28% of posterior approaches, respectively. Segmental arteries were injured in 68% of lateral approaches. Direct vessel laceration occurred in 81% of cases and recognized intraoperatively in 39% of cases. Conclusions Incidence of iatrogenic vascular injuries during thoracic and lumbar spine surgery is low but associated with an overall mortality rate up to 65%, of which less than 1% for anterior approaches and more than 50% for posterior ones. Anterior approaches for instrumented procedures are at risk of direct avulsion of CIV. Posterior instrumented fusions are at risk for injuries of iliac vessels and aorta. Lateral routes are frequently associated with lesions of segmental vessels. Suture repair and endovascular techniques are useful in the management of these severe complications.

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Management of major vascular injury during pedicle screw instrumentation of thoracolumbar spine

Cited by 21 publications

References 20 publications

Complete Disruption of The Iliac Vessels During Spinal Surgery With Delayed Presentation

Complete Disruption of The Iliac Vessels During Spinal Surgery With Delayed Presentation

Iatrogenic lumbar artery pseudoaneurysm after lumbar transpedicular fixation: Case report

Rating the incidence of iatrogenic vascular injuries in thoracic and lumbar spine surgery as regards the approach: A PRISMA-based literature review

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