title: The unusual presentation of a vascular injury after lumbar microdiscectomy: case report.
abstract: Vascular injury during lumbar spine surgery is a relatively rare complication but can have devastating outcomes. The injury may not be apparent during surgery and can present acutely or late in various manners, and some injuries can be asymptomatic. This report discusses the unusual case of a 35-year-old woman who underwent a right L4-5 microdiscectomy for disc herniation and 4 days postoperatively presented with a pulmonary embolus. A subsequent CT scan revealed a pseudoaneurysm and arteriovenous fistula of the right common iliac vein and artery, which gave rise to the embolus. The patient received a right iliac artery stent, and at 4 months after surgery she continues to be symptom free. This report describes the atypical presentation of vascular injury after lumbar microdiscectomy and stresses the importance of cautiously using the pituitary rongeur when removing deeper disc fragments.
authors.affiliation: Department of Orthopaedic Surgery, George Washington University, Washington, DC.
authors.forename: Daniel
authors.initials: D
authors.lastname: Huttman
authors.affiliation: Department of Orthopaedic Surgery, George Washington University, Washington, DC.
authors.forename: Mathew
authors.initials: M
authors.lastname: Cyriac
authors.affiliation: Department of Orthopaedic Surgery, George Washington University, Washington, DC.
authors.forename: Warren
authors.initials: W
authors.lastname: Yu
authors.affiliation: Department of Orthopaedic Surgery, George Washington University, Washington, DC.
authors.forename: Joseph R
authors.initials: JR
authors.lastname: O'Brien
mesh_terms: D000328:Adult; D017541:Aneurysm, False / Q000000981:diagnostic imaging / Q000209:etiology* / Q000628:therapy; D001164:Arteriovenous Fistula / Q000000981:diagnostic imaging / Q000209:etiology* / Q000628:therapy; D017586:Diskectomy; D005260:Female; D006801:Humans; D007083:Iliac Artery / Q000293:injuries*; D007084:Iliac Vein / Q000293:injuries*; D007405:Intervertebral Disc Displacement / Q000601:surgery*; D008159:Lumbar Vertebrae / Q000601:surgery*; D011183:Postoperative Complications; D011655:Pulmonary Embolism / Q000209:etiology*; D015607:Stents; D014057:Tomography, X-Ray Computed
keywords: AVF = arteriovenous fistula; arteriovenous fistula; lumbar disc herniation; lumbar microdiscectomy; pulmonary embolus; technique; vascular injury