Far lateral disc excision at L5-S1 complicated by iliolumbar artery incursion: case report.
OBJECTIVE
Paramedial approaches to far lateral discs at the L5-S1 space joint have advantages but may also bring the surgical space closer to large branch arteries of the internal iliac artery. I report incursion into an iliolumbar artery that required laparotomy to control hemorrhage. Surgeons performing extraforaminal disc explorations at L5-S1 need to evaluate preoperative magnetic resonance imaging scans for an enlarged iliolumbar artery near the disc space.


METHODS
The patient presented with a right L5 radiculopathy and a far lateral disc at L5-S1, as indicated by analysis of her magnetic resonance imaging scan.


METHODS
A midline incision and an extraforaminal exposure were performed. Arterial bleeding occurred when an anular disc fragment was removed with a pituitary rongeur under direct vision with microscopic magnification. Emergency laparotomy demonstrated hemorrhage from a branch of the internal iliac artery 2 cm from its origin.


CONCLUSIONS
Iliolumbar artery variants may be at the margins of extraforaminal disc exposure at L5-S1. Preoperative magnetic resonance imaging scans should be evaluated for this vasculature structure.
Harrington
J F
JF
Department of Neurosurgery, Brown University School of Medicine, Providence, Rhode Island.
D000328:Adult; D004632:Emergency Medical Services; D005260:Female; D006470:Hemorrhage / Q000209:etiology* / Q000601:surgery; D006801:Humans; D007083:Iliac Artery / Q000293:injuries*; D007403:Intervertebral Disc / Q000601:surgery*; D007405:Intervertebral Disc Displacement / Q000601:surgery*; D007431:Intraoperative Complications / Q000209:etiology / Q000601:surgery; D007813:Laparotomy; D008159:Lumbar Vertebrae; D012447:Sacrum; D014950:Wounds, Penetrating / Q000150:complications*