Segmental Artery Injury During Anterior Column Realignment: A Case Report and Review of the Literature
Keywords:Anterior column realignment, lateral lumbar interbody fusion, radicular artery, segmental artery, vascular system injuries, Endovascular hemostasis
Background: Anterior column realignment (ACR) is a minimally invasive technique used to restore lumbar lordosis and improve sagittal balance. The most feared complication from ACR includes injury to the great vessels. Segmental artery injuries are also a possible complication though sparsely reported. We report such a case.
Case Description: During anterior longitudinal ligament release at L3-4, the L3 segmental artery was injured. Intraoperative angiogram and coiling was performed. Our patient remained hemodynamically stable though during the postoperative period his hemoglobin fell five points. Discussion: This patient was at risk for this complication due to the tortuosity of his vessels and his osteophytes. This injury can be treated concurrently with endovascular embolization if equipment and personnel are readily available. Ultimately, segmental artery injury does not appear to be as morbid as great vessel injury if addressed emergently.