Aortic perforation during lateral lumbar interbody fusion.

STUDY
DESIGN: A case report.
OBJECTIVE: To report a unique case of aortic perforation during lateral lumbar interbody fusion (LLIF). SUMMARY OF BACKGROUND DATA: Among the reported advantages of this minimally invasive transpsoas procedure is the avoidance of an anterior intraperitoneal approach to the lumbar spine, thus avoiding visceral and vascular injuries typically associated with the latter.
METHODS: We report a single case of aortic perforation during LLIF, which occurred in the setting of an incidental endplate and anterior vertebral cortex violation.
RESULTS: During the implantation of an interbody prosthetic device at the L3-L4 level, the proximal aspect of the implant broke which caused cage misplacement. During the attempt to advance the well-fixed cage, distal violation of the endplate and anterior cortex of the L3 vertebra was noted, concomitant with immediate loss of blood pressure. A presumptive diagnosis of injury to a major vascular structure was quickly made, along with the decision to proceed with emergency laparotomy to repair a through-and-through laceration of the aortic terminus. After successful suture repair of the aortic lesions, the patient was kept intubated, and transferred to the intensive care unit in stable condition.
CONCLUSIONS: The distal endplate and anterior vertebral cortex violation can result in the formation of an anterior bony spur in close proximity to the major abdominal vascular structures, and despite the avoidance of an anterior approach to the lumbar spine, surgery-related injury to major abdominal vessels can occur during LLIF. Aortic perforation is a rare, yet potentially lethal intraoperative complication of LLIF, which requires emergency laparatomy and vascular suture repair.