Variable manifestations of vascular injury during lumbar disk surgery
D. C. Brewster, A. R. May, R. C. Darling, W. M. Abbott and A. C. Moncure
Major vascular injury is an unusual but well-recognized complication of
lumbar disk surgery. Clinical manifestation of such injuries may be
extremely variable. Isolated arterial laceration is most common, with early
manifestation due to retroperitoneal hemorrhage. There are often few
external signs of blood loss, however, and the diagnosis may not be
recognized initially. Formation of an arteriovenous fistula or false
aneurysm produces even fewer early signs, and diagnosis is often delayed
for weeks or years. Six cases are described that illustrate the full
spectrum of acute and chronic manifestations of such injuries. Two cases of
acute hemorrhage due to arterial trauma were seen; one case was recognized
intraoperatively and one in the recovery room. In four cases arteriovenous
fistulae developed and were diagnosed from eight hours to eight years
postoperatively. Two cases also had associated false aneurysms, one the
probable source of pulmonary emboli and one the principal manifestation of
the vascular injury.
