VASCULAR COMPLICATIONS OF LUMBAR DISCAL S URGERY - 2 CASES REPORTED AND LITERATURE REVUE OF 122 CASES

We report two cases of right lumbar common iliac arteriovenous injury after an operation on the L4-L5 disk. One case was an arteriovenous fi stula disclosed 5 years after the operation and in the other case, a p ostoperative acute haemorrhage. A retrospective study is carried out i n the literature aiming at establishing the frequency of vascular inju ry in lumbar disk surgery, their nosologic definition, and the provide d treatment. One hundred and twenty two observations were taken into a ccound. The fre quency cannot be determined. 78 of these observations (63,9%) reported an arteriovenous fistula between two elements of the aortico-cava intersection, with acute revelation (6,4%), sub-acute (19 %) or late as a right cardiac failure (64%). Thirty one cases of acute haemorrhages through isolated arterial wound (25,4%), 3 cases of arte rial or venous thrombosis (2,5%) and 10 cases of false aneurysms (8,2% ) were found. The treatment was always surgical, sometimes in high eme rgency. In the case of haemorrhage the death rate was 21% and in the e vent of fistula 1,3%. Morbidity was 11,5%, mostly due to a post-phlebi tic syndrome. These results reduce the mildness reputation of lumbar d isk surgery all the more as recording of the complications is under es timated and most of them are found far from the initial act (J Mal Vas c 1995; 20 : pages 219-223).