Iatrogenic ureteral injury secondary to a thoracolumbar lateral revision instrumentation and fusion.
BACKGROUND
Urologic, gynecologic, and colorectal surgical procedures account for most of the iatrogenic ureteral injuries; however, iatrogenic injury secondary to thoracolumbar spinal surgery remains a rare complication.


OBJECTIVE
To report a case of iatrogenic ureteral injury secondary to a thoracolumbar lateral revision instrumentation and fusion managed by percutaneous nephrostomy, ureteroureterostomy, and ureteral stent placement.


METHODS
Case report.


METHODS
A 24-year old female underwent surgical removal of a lumbar plate and broken screw with placement of a unirod spanning L1-L3 through a thoracolumbar exposure with resection of the twelfth rib.


RESULTS
On postoperative day 14 she developed left flank pain. Computed tomography scan of the abdomen and pelvis demonstrated a left perinephric fluid collection. After placement of a nephrostomy tube, a retrograde pyelogram with a concomitant antegrade nephrostogram confirmed the diagnosis of ureteral entrapment in the lumbar instrumentation. A spatulated end to end ureteral anastomosis (ureteroureterostomy) was performed over a double J ureteral stent.


CONCLUSIONS
Although an iatrogenic ureteral injury secondary to thoracolumbar surgery is rare, it should be included in the differential diagnosis for a patient presenting with flank pain after undergoing lateral thoracolumbar fusion. A urinoma, also an uncommon occurrence, may be a presenting sign. Prompt diagnosis and institution of appropriate corrective surgical procedures may result in successful outcome.
Bjurlin
Marc A
MA
Department of Surgery, Division of Urology, John H. Stroger, Jr. Hospital of Cook County, 1900 W. Polk Street, Suite 465, Chicago, IL 60612, USA.
Rousseau
Layne A
LA
Vidal
Patricia P
PP
Hollowell
Courtney M P
CM
D001860:Bone Plates; D001863:Bone Screws; D005260:Female; D006801:Humans; D007049:Iatrogenic Disease; D008159:Lumbar Vertebrae / Q000293:injuries / Q000601:surgery; D009403:Nephrostomy, Percutaneous; D011183:Postoperative Complications / Q000000981:diagnostic imaging*; D011475:Prosthesis Failure; D012086:Reoperation / Q000009:adverse effects*; D016103:Spinal Fractures / Q000601:surgery*; D013123:Spinal Fusion / Q000009:adverse effects*; D015607:Stents; D013904:Thoracic Vertebrae / Q000293:injuries / Q000601:surgery; D014057:Tomography, X-Ray Computed; D014513:Ureter / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery; D055815:Young Adult