19 Harley St, London, W1G 9QJ, UK

Nightmare of lumbar diskectomy: aorta laceration

STUDY DESIGN: Case report. OBJECTIVE: To present a rare case of a patient who during posterior lumbar spinal decompression and diskectomy underwent a laceration of the aorta. The patient survived with prompt treatment. SUMMARY OF BACKGROUND DATA: Intraoperative injuries of the prevertebral and pelvic vessels are infrequent but serious complications of posterior lumbar disc surgery. Injury may cause laceration of the vessel with acute life-threatening retroperitoneal hemorrhage, which is usually massive. The aortic bifurcation is closely approximated to the anterior surface of the L4-L5 disc. METHODS: A 70-year-old gentleman with prolapsed intervertebral disc between fourth and fifth lumbar vertebrae and left-sided radiculopathy of L5 root was operated with L4-L5 laminectomy and L4-L5 diskectomy. During diskectomy, it was noticed by the surgeon that there was one episode of giving way of the pituitary rongeur anteriorly. However, no major bleeding was encountered from the disc space immediately after the event; vital signs were stable hemodynamically and we completed the diskectomy. Five minutes later, we noted the dural sac to have a collapsing pulsation. Prevertebral vessel injury was suspected. Patient became pulseless. RESULTS: We turned the patient supine for cardiopulmonary resuscitation without extubation. Vascular surgeons proceeded with laparotomy. Huge retroperitoneal hematoma and a 1.5 x 1.5 cm laceration at the bifurcation of aorta were noted anterior to the L4-L5 intervertebral disc. The vascular surgeon repaired the aorta by primary repair. The patient was extubated on day 5 and was allowed to ambulate. He was discharged subsequently with a normal neurological and vascular examination. No pseudoaneurysm or arteriovenous fistula formation was detected on magnetic resonance imaging and magnetic resonance angiography at 2 years follow-up. CONCLUSION: Iatrogenic vascular injury during posterior lumbar disc surgery, although rare, should be suspected if signs of circulatory instability or abnormal pulsation of the dural sac are noted, especially if any lapse in the ordinary technique has been observed. In preoperative imaging, note the position of the aorta and prevertebral veins and the depth and integrity of the anterior wall of the disc

Keywords : adverse effects,Aged,Angiography,Aorta,Arteriovenous Fistula,complications,Diskectomy,etiology,Hematoma,Hemorrhage,Humans,injuries,Intervertebral Disc,Intraoperative Complications,Lacerations,Laminectomy,Lumbar Vertebrae,Magnetic Resonance Angiography,Magnetic Resonance Imaging,Male,methods,Radiculopathy,surgery,Treatment Outcome,Veins,, Lumbar,Diskectomy,Aorta,Laceration, london pain clinic prices

Date of Publication : 2011 Dec 15

Authors : Yip SL;Woo SB;Kwok TK;Mak KH;

Organisation : Department of Orthopaedics and Traumatology, Kwong Wah Hospital, Hong Kong. [email protected]

Journal of Publication : Spine (Phila Pa 1976 )

Pubmed Link : https://www.ncbi.nlm.nih.gov/pubmed/22138785

The London Spine Unit : Harley Street UK. Specialists in Cutting Edge Technologies for Spinal Surgery

Make an Appointment 

Trustpilot Reviews
Doctify Reviews
Top Doctor Reviews

Nightmare of lumbar diskectomy aorta laceration | Frozen shoulder heat or ice

What our patients say ...

Consultant Spine Surgeon
Consultant Spine Surgeon
Consultant Spine Surgeon

This surgical technique consists of a percutaneous approach for the treatment of small to medium size hernias of the intervertebral disc by laser energy. The main objective is to reduce the intradiscal pressure in the nucleus pulposus

Laser Disc Surgery can be performed under local anaesthetic as a day case at our centre on the prestigious Harley Street.
What is London spine unit and How it Works

The London Spine Unit was established in 2005 and has successfully treated over 5000 patients. All conditions are treated.

treatment of all spinal disorders

The London Spine Unit specialises in Minimally Invasive Treatments allowing rapid recovery and return to normal function

Trusted by patients worldwide

The London Spine Unit provides the highest quality care to all patients and has VIP services for those seeking exceptional services

If you have any emergency Doctor’s need, simply call our 24 hour emergency

Your personal case manager will ensure that you receive the best possible care.

Call Now 

+44 844 589 2020
+44 203 973 8810