Retroperitoneal hemorrhage after lumbar disc surgery: Importance of follow-up CT for detection of vascular complications

The objective of this study was to demonstrate the role of major surgery on patients presenting with vascular complications after lumbar disc surgery. A retrospective analysis of seven cases treated surgically in two tertiary care centers between August 2001 and June 2010 was carried out. The average age of patients (three women and four men) was 35.8 ± 7.2. The most common vessel injured was the left common iliac artery occurring in five patients (71.4%), followed by the left common iliac vein injury detected in two patients (28.5%). Transperitoneal approach was preferred in all cases and primary suturing, graft interposition and end-to-end anastomoses were the surgical methods used for the repair of vascular injury. No mortality was seen in our series during the follow-up period of two years; however, the most noteworthy complication was paraplegia occurring in one patient. Vascular injury occurring at lumbar discus surgery has a considerable potential for morbidity and mortality. A high index of suspicion is necessary for early diagnosis. In hemodynamically instable patients, the transperitoneal approach provides better exposure and more effective control of hemorrhage, while minimal angiography and endovascular intervention should be preserved for hemodynamically stable cases.

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Vascular complications of lumbar disc surgery

Acta Neurochirurgica ◽

10.1007/bf01411278 ◽

1996 ◽

Vol 138 (8) ◽

pp. 912-916 ◽

Cited By ~ 38

Author(s):

J. Fruhwirth ◽

G. Koch ◽

W. Amann ◽

H. Hauser ◽

G. Flaschka

Keyword(s):

Lumbar Disc ◽

Vascular Complications ◽

Lumbar Disc Surgery ◽

Disc Surgery

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Seven-year clinical follow-up after lumbar disc surgery: results and predictors of outcome

British Journal of Neurosurgery ◽

10.1080/02688699943952 ◽

1999 ◽

Vol 13 (2) ◽

pp. 178-184 ◽

Cited By ~ 49

Author(s):

V. GRAVER ◽

A. K. HAALAND ◽

B. MAGNAS ◽

M. LOEB

Keyword(s):

Lumbar Disc ◽

Lumbar Disc Surgery ◽

Predictors Of Outcome ◽

Disc Surgery

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A Shift Toward Endovascular Repair for Vascular Complications in Lumbar Disc Surgery During the Last Decade

Annals of Vascular Surgery ◽

10.1016/j.avsg.2012.07.019 ◽

2013 ◽

Vol 27 (6) ◽

pp. 810-819 ◽

Cited By ~ 27

Author(s):

Moniek van Zitteren ◽

Boxing Fan ◽

Paul N. Lohle ◽

J. Cees de Nie ◽

Jan de Waal Malefijt ◽

...

Keyword(s):

Endovascular Repair ◽

Lumbar Disc ◽

Vascular Complications ◽

Lumbar Disc Surgery ◽

Disc Surgery

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The effect of preoperative dexamethasone on pain 1 year after lumbar disc surgery: a follow-up study

BMC Anesthesiology ◽

10.1186/s12871-016-0277-z ◽

2016 ◽

Vol 16 (1) ◽

Cited By ~ 4

Author(s):

Rikke Vibeke Nielsen ◽

Jonna Fomsgaard ◽

Ole Mathiesen ◽

Jørgen Berg Dahl

Keyword(s):

Lumbar Disc ◽

Lumbar Disc Surgery ◽

Follow Up Study ◽

Disc Surgery

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Challenges in the Analysis of Longitudinal Pain Data: Practical Lessons from a Randomized Trial of Annular Closure in Lumbar Disc Surgery

Pain Research and Treatment ◽

10.1155/2019/3498603 ◽

2019 ◽

Vol 2019 ◽

pp. 1-6

Author(s):

Gerrit J. Bouma ◽

Martin Barth ◽

Larry E. Miller ◽

Sandro Eustacchio ◽

Charlotte Flüh ◽

...

Keyword(s):

Lumbar Disc ◽

Lumbar Discectomy ◽

Pain Severity ◽

Leg Pain ◽

Lumbar Disc Surgery ◽

Integrated Analysis ◽

Pain Scores ◽

Disc Surgery ◽

Unadjusted Analysis

Purpose. To analyze leg pain severity data from a randomized controlled trial (RCT) of lumbar disc surgery using integrated approaches that adjust pain scores collected at scheduled follow-up visits for confounding clinical events occurring between visits. Methods. Data were derived from an RCT of a bone-anchored annular closure device (ACD) following lumbar discectomy versus lumbar discectomy alone (Control) in patients with large postsurgical annular defects. Leg pain was recorded on a 0 to 100 scale at 6 weeks, 3 months, 6 months, 1 year, and 2 years of follow-up. Patients with pain reduction ≥20 points relative to baseline were considered responders. Unadjusted analyses utilized pain scores reported at follow-up visits. Since symptomatic reherniation signifies clinical failure of lumbar discectomy, integrated analyses adjusted pain scores following a symptomatic reherniation by baseline observation carried forward for continuous data or classification as nonresponders for categorical data. Results. Among 550 patients (272 ACD, 278 Control), symptomatic reherniation occurred in 10.3% of ACD patients and in 21.9% of controls (p < 0.001) through 2 years. There was no difference in leg pain scores at the 2-year visit between ACD and controls (12 versus 14; p = 0.33) in unadjusted analyses, but statistically significant differences favoring ACD (19 versus 29; p < 0.001) in integrated analyses. Unadjusted nonresponder rates were 6.0% with ACD and 6.7% with controls (p = 0.89), but 15.7% and 27.8% (p = 0.001) in integrated analyses. The probability of nonresponse was 16.4% with ACD and 18.3% with controls (p = 0.51) in unadjusted analysis, and 23.7% and 31.2% (p = 0.04) in integrated analyses. Conclusion. In an RCT of lumbar disc surgery, an integrated analysis of pain severity that adjusted for the confounding effects of clinical failures occurring between follow-up visits resulted in different conclusions compared to an unadjusted analysis of pain scores reported at follow-up visits only.

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Manipulative rehabilitation applied soon after lumbar disc surgery improves late post-operative functional disability: A preliminary 2-year follow-up study

Journal of Back and Musculoskeletal Rehabilitation ◽

10.3233/bmr-169546 ◽

2017 ◽

Vol 30 (5) ◽

pp. 999-1004 ◽

Cited By ~ 2

Author(s):

Byungho J. Kim ◽

Taeyeong Kim ◽

Junghoon Ahn ◽

Heecheol Cho ◽

Dongyun Kim ◽

...

Keyword(s):

Functional Disability ◽

Lumbar Disc ◽

Lumbar Disc Surgery ◽

Follow Up Study ◽

Disc Surgery

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Vascular complications related to lumbar disc surgery

Journal of Neurosurgery Spine ◽

10.3171/spi.2004.100.3.0249 ◽

2004 ◽

Vol 100 (3) ◽

pp. 249-253 ◽

Cited By ~ 16

Author(s):

Hakan Bingol ◽

Faruk Cingoz ◽

Ahmet Turan Yilmaz ◽

Mehmet Yasar ◽

Harun Tatar

Keyword(s):

Vascular Injury ◽

Postoperative Period ◽

Lumbar Disc ◽

Vascular Complications ◽

Lumbar Disc Surgery ◽

Dacron Graft ◽

Content Type ◽

Disc Surgery ◽

Late Postoperative Period ◽

Fine Print

Object. Vascular complications related to lumbar disc operations are rare but extremely fatal conditions. The authors analyzed data retrospectively obtained in 13 patients with vascular complications that occurred during lumbar disc operations performed between January 1990 and January 2002. Methods. One patient underwent an L5—S1 procedure and the remaining underwent L4–5 surgery. Missed injuries, which were found during the late postoperative period, included pseudoaneurysm in four cases and an arteriovenous fistula in one. In all cases except one in which complication occurred early in the postoperative period, the retroperitoneal area was reached via a transperitoneal approach. In eight patients with complications occurring early in the postoperative period, Dacron graft was placed in four with arterial injuries and saphenous vein graft in one. In three cases of arterial injury and five of venous injury, the lesion was repaired using the primer suture technique. The most commonly affected vessels were left common iliac arteries (76.9%) and left common iliac vein (30.8%). In eight early cases, shock or preshock due to hemorrhage developed during the early phase. During the late postoperative period, graft-related infection occurred in two cases in which Dacron graft was placed, and axillofemoral extraanatomical bypass surgery was later performed. There was no surgery-related death. During a mean follow-up period of 5.6 years, none of the patients suffered any problems related to vascular injury. Conclusions. Despite its low incidence, iatrogenic vascular injury related to lumbar disc surgery is a possible complication. During lumbar disc operations early diagnosis of vascular injuries and urgent transperitoneal surgery can save patients' lives.

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