Liehua Liu1, Nan Li2, Qian Wang3, Haoming Wang2, Yuexiang Wu4, Weidong Jin5, Qiang Zhou6, Zili Wang7. 1. Graduate School, Ningxia Medical University, Yinchuan, Ningxia Hui Autonomous Region, China; Department of Spine Surgery, The Third Affiliated Hospital of Chongqing Medical University (General Hospital), Chongqing, China. 2. Department of Orthopedics, Three Gorges Central Hospital, Chongqing, China. 3. Hillsborough Community College, Tampa, Florida, USA. 4. Outpatient Department, General Hospital, Ningxia Medical University, Yinchuan, Ningxia Hui Autonomous Region, China. 5. Department of Spinal Surgery, General Hospital, Ningxia Medical University, Yinchuan, Ningxia Hui Autonomous Region, China. 6. Department of Spine Surgery, The Third Affiliated Hospital of Chongqing Medical University (General Hospital), Chongqing, China. 7. Department of Spinal Surgery, General Hospital, Ningxia Medical University, Yinchuan, Ningxia Hui Autonomous Region, China. Electronic address: wangzlnx@126.com.
Abstract
BACKGROUND: We reviewed the reported data related to iatrogenic lumbar artery injury (ILAI) in spine surgery with a focus on which iatrogenic procedure might cause lumbar artery injury. METHODS: We conducted a comprehensive search in the Web of Science, PubMed, EMBASE, and Chinese biomedical databases in July 2018. RESULTS: A total of 20 reports on ILAI were selected for the present study. Most of these were case reports, with a total of 26 cases. The causes of ILAI were as follows: puncture injury in 9 cases, transforaminal endoscopic operation in 5 cases, pedicle screw injury in 3 cases, intervertebral foramen decompression in 2 cases, disc rongeur injury during discectomy in 2 cases, lumbar artery tear caused by transverse process fracture in 1 case, vertebral fracture restoration in 1 case, retractor injury in 1 case, cage insertion or pedicle screw injury in 1 case, and drainage tube stimulation in 1 case. The treatment methods included transarterial embolization in 20 cases, percutaneous embolization in 2 cases, surgical ligation in 1 case, and steroid and cyclophosphamide treatment in 1 case. All patients were treated successfully. One patient died during antishock therapy, and another patient died because her family refused any further intervention. CONCLUSIONS: Attention should be given to the surgical procedures that are likely to cause ILAI, such as percutaneous vertebroplasty/percutaneous kyphoplasty, vertebral biopsy, pedicle screw implantation, discectomy, transforaminal endoscopic operation, and intervertebral foramen decompression. Once a diagnosis of ILAI has been confirmed, selective endovascular transarterial embolization is the preferred treatment.
BACKGROUND: We reviewed the reported data related to iatrogenic lumbar artery injury (ILAI) in spine surgery with a focus on which iatrogenic procedure might cause lumbar artery injury. METHODS: We conducted a comprehensive search in the Web of Science, PubMed, EMBASE, and Chinese biomedical databases in July 2018. RESULTS: A total of 20 reports on ILAI were selected for the present study. Most of these were case reports, with a total of 26 cases. The causes of ILAI were as follows: puncture injury in 9 cases, transforaminal endoscopic operation in 5 cases, pedicle screw injury in 3 cases, intervertebral foramen decompression in 2 cases, disc rongeur injury during discectomy in 2 cases, lumbar artery tear caused by transverse process fracture in 1 case, vertebral fracture restoration in 1 case, retractor injury in 1 case, cage insertion or pedicle screw injury in 1 case, and drainage tube stimulation in 1 case. The treatment methods included transarterial embolization in 20 cases, percutaneous embolization in 2 cases, surgical ligation in 1 case, and steroid and cyclophosphamide treatment in 1 case. All patients were treated successfully. One patient died during antishock therapy, and another patient died because her family refused any further intervention. CONCLUSIONS: Attention should be given to the surgical procedures that are likely to cause ILAI, such as percutaneous vertebroplasty/percutaneous kyphoplasty, vertebral biopsy, pedicle screw implantation, discectomy, transforaminal endoscopic operation, and intervertebral foramen decompression. Once a diagnosis of ILAI has been confirmed, selective endovascular transarterial embolization is the preferred treatment.