Vascular injury during lumbar diskectomy associated with peridiskal fibrosis: case report and literature review.

Dense peridiskal fibrosis was encountered during a lumbar diskectomy for a chronic lumbar disk herniation. Posteriorly the adhesions involved the annulus, dura mater, nerve roots, posterior longitudinal ligament, and sequestrated disk material. Anteriorly the iliac vessels were also densely adherent to the disk. When disk material was removed from a standard posterior approach, the left common iliac vein tore, leading to severe hypotension. Vascular injury by instruments has been described by many clinicians, but this indirect mechanism of injury has not been reported in the literature, nor has extensive peridiskal fibrosis been described in a spine without a history of previous surgery.