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Emergency treatment for iatrogenic lumbar arterial injury occurred during posterior lumbar interbody fusion: a case report

  • Sangun Nah1,†
  • Sangsoo Han1,†
  • Young Soon Cho1,*,

1Department of Emergency Medicine, Soonchunhyang University Bucheon Hospital, 14584 Bucheon, Republic of Korea

DOI: 10.22514/sv.2023.100

Submitted: 19 May 2023 Accepted: 27 June 2023

Online publish date: 26 October 2023

*Corresponding Author(s): Young Soon Cho E-mail: emer0717@schmc.ac.kr

† These authors contributed equally.

Abstract

An iatrogenic vessel injury occurring during lumbar fusion is a rare but potentially serious complication. In this case report, we present a case of hypovolemic cardiac arrest attributable to an iatrogenic lumbar artery injury that occurred during posterior lumbar interbody fusion (PLIF), which is difficult to diagnose using CECT. A 70-year-old woman underwent PLIF surgery in a primary hospital for the treatment of degenerative spondylolisthesis (L2–L5). During the procedure, she experienced a blood loss of 3 liters, which necessitated the transfusion of packed red blood cells (6 units, about 200–250 mL per unit), fresh frozen plasma (6 units, about 150–170 mL per unit). Despite the transfusions, her vital signs remained unstable, leading to her transfer to our hospital. Upon arrival at our facility, the patient went into cardiac arrest, but spontaneous circulation was successfully restored after two cycles of cardiopulmonary resuscitation. In the emergency department, her hemoglobin level was measured at 2.7 g/dL, platelet level at 56,000/µL, and prothrombin international normalized ratio at 3.56. CECT did not indicate any active bleeding. For the initial 2 hours, her vital signs remained stable with a blood pressure of 92/53 mmHg, heart rate of 104 bpm, respiratory rate of 22 bpm. However, her blood pressure suddenly dropped to 78/43 mmHg. Subsequent angiography revealed active bleeding from the right fourth lumbar artery, prompting the performance of embolization. Following the procedure, the patient’s vital signs stabilized, and she was discharged on the 16th day of hospitalization. Iatrogenic vessel injuries during PLIF may pose challenges in their detection using CECT, especially when extravasation is not definitively visible or when artifacts are created by metal implants. Therefore, it is advisable for emergency physicians to consider emergency angiography in the diagnosis and treatment of such vessel injuries.


Keywords

Iatrogenic injury; Posterior lumbar interbody fusion; Angiography


Cite and Share

Sangun Nah,Sangsoo Han,Young Soon Cho. Emergency treatment for iatrogenic lumbar arterial injury occurred during posterior lumbar interbody fusion: a case report. Signa Vitae. 2024.doi:10.22514/sv.2023.100.

References

[1] Lenz M, Mohamud K, Bredow J, Oikonomidis S, Eysel P, Scheyerer MJ. Comparison of different approaches in lumbosacral spinal fusion surgery: a systematic review and meta-analysis. Asian Spine Journal. 2022; 16: 141–149.

[2] Said E, Abdel-Wanis ME, Ameen M, Sayed AA, Mosallam KH, Ahmed AM, et al. Posterolateral fusion versus posterior lumbar interbody fusion: a systematic review and meta-analysis of randomized controlled trials. Global Spine Journal. 2022; 12: 990–1002.

[3] Youn YH, Cho KJ, Na Y, Kim JS. Global sagittal alignment and clinical outcomes after 1–3 short-segment lumbar fusion in degenerative spinal diseases. Asian Spine Journal. 2022; 16: 551–559.

[4] Liu L, Li N, Wang Q, Wang H, Wu Y, Jin W, et al. Iatrogenic Lumbar artery injury in spine surgery: a literature review. World Neurosurgery. 2019; 122: 266–271.

[5] Ruffilli A, Barile F, Fiore M, Pasini S, Facchini G, Faldini C. Occurrence of L4 lumbar artery pseudoaneurysm after posterior reduction and L4–L5 fusion for grade I anterolisthesis: a case report. JBJS Case Connector. 2020; 10: e20.

[6] Maturen KE, Adusumilli S, Blane CE, Arbabi S, Williams DM, Fitzgerald JT, et al. Contrast-enhanced CT accurately detects hemorrhage in torso trauma: direct comparison with angiography. Journal of Trauma and Acute Care Surgery. 2007; 62: 740–745.

[7] Sugimoto Y, Tanaka M, Gobara H, Misawa H, Kunisada T, Ozaki T. Management of lumbar artery injury related to pedicle screw insertion. Acta Medica Okayama. 2013; 67: 113–116.

[8] Nijenhuis RJ, Sluzewski M, van Rooij WJ. Iatrogenic lumbar pseudoaneurysm causing dural sac compression after spine surgery. Journal of Neurosurgery: Spine. 2009; 10: 585–586.

[9] Makino T, Kaito T, Sakai Y, Takenaka S, Yoshikawa H. Iatrogenic arteriovenous fistula and retroperitoneal hemorrhage after tapping of lumbar pedicle screws: a case report. JBJS Case Connector. 2019; 9: e0477.

[10] Alzain AF, Elhussein N, Fadulelmulla IA, Ahmed AM, Elbashir ME, Elamin BA. Common computed tomography artifact: source and avoidance. Egyptian Journal of Radiology and Nuclear Medicine. 2021; 52: 151.

[11] Dunsker SB, Caglar S, Dolgun H, Ugur HC, Torun F, Attar A, et al. Extraforaminal lumbar arterial anatomy. Surgical Neurology. 2004; 61: 29–33.

[12] Pinho AR, Pereira PA, Leite MJ, Santos CC, Vaz RP, Dulce MM. The surgical vascular anatomy of the lower lumbar arteries and its implications in minimally invasive spine surgery: a cadaveric study. International Journal of Spine Surgery. 2022; 16: 631–637.

[13] Puvanesarajah V, Liauw JA, Lo SF, Lina IA, Witham TF. Techniques and accuracy of thoracolumbar pedicle screw placement. World Journal of Orthopedics. 2014; 5: 112–123.

[14] Gu W, Fan N, Liao H. Fitting aggregated phase-type distributions to the length-of-stay in intra-hospital patient transfers. Operations Research for Health Care. 2021; 29: 100291.

[15] Castellini G, Gianola S, Biffi A, Porcu G, Fabbri A, Ruggieri MP, et al. Resuscitative endovascular balloon occlusion of the aorta (REBOA) in patients with major trauma and uncontrolled haemorrhagic shock: a systematic review with meta-analysis. World Journal of Emergency Surgery. 2021; 16: 41.

[16] Nakai S, Uchida T, Kuroda Y, Yamashita A, Ohba E, Mizumoto M, et al. Spontaneous lumbar artery injury resulting in retroperitoneal hematoma mimicking abdominal aortic aneurysm rupture. Annals of Vascular Diseases. 2021; 14: 384–387.

[17] Akhaddar A, Alaoui M, Turgut M, Hall W. Iatrogenic vascular laceration during posterior lumbar disc surgery: a literature review. Neurosurgical Review. 2021; 44: 821–842.


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