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How to manage a ureteral injury after anterior lumbar spine interbody fusion surgery – Lumbar Fusion

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This article discusses the management of a rare complication following anterior lumbosacral interbody fusion (ALIF) surgery, specifically a ureteral injury. ALIF surgery is commonly used to treat various conditions such as discogenic back pain, spondylolisthesis, and degenerative lumbar scoliosis. The surgery offers advantages such as reduced blood loss, decreased postoperative pain, and improved fusion rates. However, in this case, a 35-year-old man experienced abnormal abdominal pains after the surgery and was diagnosed with a ureteral fistula. Initial attempts at treatment failed, but the injury was eventually resolved with ureterovesical reimplantation. The patient recovered well without any urinary sequelae. The authors emphasize the importance of cautious dissection in the retroperitoneal area during ALIF surgery to prevent such rare complications

Summarised by Mr Mo Akmal – Lead Spinal Surgeon
The London Spine Unit : most specialised day surgery unit in London

Published article

: Although ureteral lesions during ALIF surgery are extremely uncommon, surgeons must be cautious when dissecting the retroperitoneal area. A methodical identification of the ureter might guarantee the security of each surgery, especially for patients who have undergone previous abdominal interventions.

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Neurochirurgie. 2023 Sep 27:101503. doi: 10.1016/j.neuchi.2023.101503. Online ahead of print.ABSTRACTBACKGROUND: Anterior lumbosacral interbody fusion (ALIF) surgery is a predominant approach used in various indications such as treating discogenic back pain, spondylolisthesis, degenerative lumbar scoliosis, intervertebral foraminal stenosis, or spondylolysis. In comparison with posterior conventional approach, ALIF surgery has several advantages: direct access to the spine,

Neurochirurgie. 2023 Sep 27:101503. doi: 10.1016/j.neuchi.2023.101503. Online ahead of print.

ABSTRACT

BACKGROUND: Anterior lumbosacral interbody fusion (ALIF) surgery is a predominant approach used in various indications such as treating discogenic back pain, spondylolisthesis, degenerative lumbar scoliosis, intervertebral foraminal stenosis, or spondylolysis. In comparison with posterior conventional approach, ALIF surgery has several advantages: direct access to the spine without muscle dissection, reduced blood loss, decreased postoperative pain, and improved fusion rates. Rare complications following ALIF surgery need to be reported, therefore the authors present an uncommon case of a ureteral injury diagnosed early after surgery and its management.

MANAGEMENT OF A URINOMA: Herein, we present a case of a 35-year-old man who presented with abnormal abdominal pains 4 days after ALIF surgery. He was diagnosed with a distal left iatrogenic ureteral fistula on a contrast enhanced CT. After the initial endoscopic approach with double J stent and urinary catheter drainage insertion had failed, the injury was finally treated with ureterovesical reimplantation. At the last follow-up, the patient did well without any clinical or biological urinary sequelae after this grade IIIb complication on the Clavien Dindo Scale.

: Although ureteral lesions during ALIF surgery are extremely uncommon, surgeons must be cautious when dissecting the retroperitoneal area. A methodical identification of the ureter might guarantee the security of each surgery, especially for patients who have undergone previous abdominal interventions.

PMID:37774911 | DOI:10.1016/j.neuchi.2023.101503

The London Spine Unit : most specialised day surgery unit in London

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How to manage a ureteral injury after anterior lumbar spine interbody fusion surgery

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Neurochirurgie. 2023 Sep 27:101503. doi: 10.1016/j.neuchi.2023.101503. Online ahead of print.ABSTRACTBACKGROUND: Anterior lumbosacral interbody fusion (ALIF) surgery is a predominant approach used in various indications such as treating discogenic back pain, spondylolisthesis, degenerative lumbar scoliosis, intervertebral foraminal stenosis, or spondylolysis. In comparison with posterior conventional approach, ALIF surgery has several advantages: direct access to the spine

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