title: Major vessel injury with cage migration: surgical complication in a case of spondylodiscitis.
abstract: METHODS
  Case report.
  
  
  OBJECTIVE
  To report the unique nature of a technique-related complication with major vessel injury in case of lumbar spondylodiscitis.
  
  
  BACKGROUND
  Perioperative major vessel injuries during spinal surgeries are uncommon but are reported complications. The unusual nature of the complication and its prognostic dilemma is the purpose of this case report.
  
  
  METHODS
  A 55-year-old woman presented with infective L3-L4 spondylodiscitis and was offered transforaminal lumbar interbody fusion surgery. Intraoperative manipulation to attain optimum cage position resulted in its dislodgement anteriorly and vessel injury with torrential hemorrhage, which was successfully managed surgically without mortality.
  
  
  RESULTS
  On thorough investigation in the postoperative period, the cage was found to have migrated to the left pulmonary artery. The patient recovered completely of her preoperative status and is asymptomatic 6 months after surgery.
  
  
  CONCLUSIONS
  The presented complication is a catastrophe considering a routine surgical procedure. In cases of spondylodiscitis, spine surgeons should be careful about inflammation of major vessels with friable vessel walls anterior to the vertebrae. This mandates a cautious surgical technique.
authors.affiliation: Department of Orthopedics, P. D. Hinduja National Hospital and Research Centre, Mahim, Mumbai, Maharashtra, India. umporthodoc@yahoo.com
authors.forename: Uday M
authors.initials: UM
authors.lastname: Pawar
authors.forename: Vishal
authors.initials: V
authors.lastname: Kundnani
authors.forename: Abhay
authors.initials: A
authors.lastname: Nene
mesh_terms: D001808:Blood Vessels / Q000293:injuries; D015299:Discitis / Q000601:surgery*; D005260:Female; D006470:Hemorrhage / Q000209:etiology* / Q000601:surgery; D006801:Humans; D008159:Lumbar Vertebrae / Q000473:pathology / Q000601:surgery*; D008875:Middle Aged; D013123:Spinal Fusion / Q000009:adverse effects* / Q000379:methods; D016896:Treatment Outcome