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

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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