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

Abstract 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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Damage to vessels and retroperitoneal organs during lumbar spine surgery through the posterior approach

Russian journal of neurosurgery ◽

10.17650/1683-3295-2018-20-2-35-42 ◽

2018 ◽

Vol 20 (2) ◽

pp. 35-42

Author(s):

A. A. Grin’ ◽

R. A. Kovalenko ◽

N. А. Konovalov ◽

D. V. Efimov ◽

A. V. Antonov ◽

...

Keyword(s):

Lumbar Spine ◽

Spine Surgery ◽

Posterior Approach ◽

Iliac Vein ◽

Herniated Disc ◽

Lumbar Spine Surgery ◽

Common Iliac Vein ◽

Study Objective ◽

Left Common Iliac Vein ◽

Abdominal Organs

The study objective is to summarize the existing literature and own experience related to damage to vessels, retroperitoneal organs, and abdominal organs during lumbar spine surgery through the posterior approach, as well as to identify risk factors associated with this damage and to describe measures for their elimination and prevention.Materials and methods. In addition to analyzing the research literature, we also described 9 cases (3 males and 6 females; mean age 52 ± 9 years) of intraoperative damage to vessels and adjacent organs during lumbar spine surgery for some degenerative disease, including herniated disc (n = 7), anterolisthesis (n = 1), and vertebral-motor segment instability (n = 1). The surgery was performed at the L4–L5 level (n = 7) and L5–S1 level (n = 2). Results. The damages observed in the cohort analyzed were caused by a conchotome (n = 6), transpedicular screw (n = 1), Volkmann spoon (n = 1), and a tip of the SpineJet Hydrodiscectomy System (n = 1). The following structures were damaged; left common iliac vein (n = 2), left common iliac artery (n = 2), left common iliac vein and root of the small-bowel mesentery (n = 1), sigmoid colon (n = 1), aorta (n = 1), inferior vena cava (n = 1), and aortocaval anastomosis (n = 1). Five patients had intraoperative hemorrhagic complications. Four patients were found to have damage to vessels or abdominal organs later (1 h, 2 h, 3 days, and 4 months postoperatively). Four patients were discharged without consequences; 2 patients became disabled; 3 patients died.Conclusion. Damage to vessels, retroperitoneal organs, and abdominal organs during lumbar spine surgery through the posterior approach is a rare, but mortally dangerous complication. Spine surgery should be performed in multi-unit hospitals that have a surgery unit, a vascular surgery unit, an intensive care unit, and a sufficient supply of blood for transfusion.

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