VASCULAR COMPLICATIONS IN LUMBAR-DISK SURGERY - REPORT OF 4 CASES

Vascular injuries in lumbar disk surgery, although rare, are serious c omplications which may be overlooked due to a broad range of clinical manifestations. It is important that surgeons and radiologists be awar e of these potentially fatal complications and develop an appropriate symptom-based diagnostic paradigm. We reviewed 8099 consecutive cases of lumbar disk surgery, performed over a 14-year period at a single in stitution, for postoperative vascular complications. We identified fou r patients (0.05%) with lumbar disk surgery-related vascular complicat ions: intraoperative lacerations of the abdominal aorta and median sac ral artery, an arteriovenous fistula between the left common iliac art ery and vein detected 19 days postdiskectomy, and a partially thrombos ed aortic aneurysm with an arteriovenous fistula between the aneurysm and the inferior vena cava, diagnosed 11 months after surgery. The maj ority of cases in the literature of vascular injury in lumbar disk sur gery were reported prior to 1965. Diagnostic approaches described in t hat period do not reflect the great range of diagnostic techniques ava ilable today. Angiography remains the gold standard for diagnosis and guidance as to surgical repair. However, a high index of suspicion bas ed on clinical signs and/or the use of sonography or CT is important i n the detection of these complications.