Page 165 - Read Online

Tummala et al. Postoperative complications of spinal surgery

out of which 13 (6.1%) vascular injuries occurred of Conflicts of interest
which 5 were major (38.5%). One major arterial injury There are no conflicts of interest.
(0.5%) occurred and required arterial thrombectomy
and stent placement. A case report of an acute Patient consent
[9]
Leriche-like syndrome after posterior instrumentation Appropriate consent was obtained from the patient
of the spine highlighting iatrogenic trauma to the regarding the usage of details for educational purposes.
aorta during spinal surgeries was described by in a
47-year-old female who developed an acute occlusion Ethics approval
of the infrarenal aorta after posterior transpedicular
instrumentation of an L1 burst-fracture. [13] This case report is waived for ethical approval.

In the literature review, it was found that ALIF surgery REFERENCES
at L2-L5 levels is most likely prone to cause vascular
injury, [3-5] just as the procedure in our case. The 1. Lee WJ, Cheng YZ, Lin HJ. Leriche’s syndrome. Int J Emerg Med
explained reason is that left common iliac vessels 2. 2008;1:223.
Kakkos SK, Shepard AD. Delayed presentation of aortic injury by
normally transverse the prevertebral space the L4-5 pedicle screws: report of two cases and review of the literature. J Vasc
interspace, and thus prevents direct access to the Surg 2008;47:1074-82.
spine. These vessels must be mobilized with the help of 3. Baker JK, Reardon PR, Reardon MJ, Heggeness MH. Vascular injury
retractors from left to right to expose the bony midline. in anterior lumbar surgery. Spine (Phila Pa 1976) 1993;18:2227-30.
[8]
And there might be a progression of the injury from iliac 4. Brau SA, Delamarter RB, Schiffman ML, Williams LA, Watkins RG.
artery upwards to the aorta. We believe the retraction Vascular injury during anterior lumbar surgery. Spine J 2004;4:409-12.
of vessels can promote thrombus formation, through 5. Kulkarni SS, Lowery GL, Ross RE, Ravi Sankar K, Lykomitros V.
a mechanical injury to the intima of the artery. The Arterial complications following anterior lumbar interbody fusion:
mechanism of thrombus formation is detailed below. 6. report of eight cases. Eur Spine J 2003;12:48-54.
Jawor WJ, Plice SG. Thrombotic obliteration of the abdominal aorta;
The retraction of the artery is considered as a non- report of a case. J Am Med Assoc 1952;149:142-3.
penetrating arterial injury which has been shown that 7. Faciszewski T, Winter RB, Lonstein JE, Denis F, Johnson L. The
stretching of the artery can cause a rupture of the intimal surgical and medical perioperative complications of anterior spinal
layer. [14] The second reasoning is vascular retraction fusion surgery in the thoracic and lumbar spine in adults. A review of
causes turbulent flow near the retraction site. The 1223 procedures. Spine (Phila Pa 1976) 1995;20:1592-9.
disturbance in normal flow cause platelets to adhere 8. Wood KB, Devine J, Fischer D, Dettori JR, Janssen M. Vascular
to the injured endothelium and lead to the process of injury in elective anterior lumbosacral surgery. Spine (Phila Pa 1976)
primary hemostasis. [15] The turbulent flow also prevents 2010;35:S66-75.
dilution by fresh flowing blood with activated clotting 9. Heary RF, Benzel EC, Vaicys C. Anterior lumbar interbody fusion.
In: Benzel’s Spine surgery: Techniques, Complication, Avoidance,
factors, which promote secondary hemostasis and and Management, 2nd ed. Philadelphia: Elsevier; 2005. p. 474-85.
eventual thrombus formation. [15] The aortic occlusion 10. Garg J, Woo K, Hirsch J, Bruffey JD, Dilley RB. Vascular
of Leriche’s syndrome is usually caused by diffuse complications of exposure for anterior lumbar interbody fusion. J
atherosclerotic changes, exacerbated by smoking, Vasc Surg 2010;51:946-50.
diabetes, hypertension, and hypercholesterolemia. 11. McCoy CE, Patierno S, Lotfipour S. Leriche syndrome presenting
[1]
However, iatrogenic trauma to the blood vessels as a with multisystem vaso-occlusive catastrophe. West J Emerg Med
cause for thrombosis has been documented. [16] 2015;16:583-6.
12. Yoon DH, Cho H, Seol SJ, Kim T. Right calf claudication revealing
The retraction of iliac vessels in our case during leriche syndrome presenting as right sciatic neuropathy. Ann Rehabil
Med 2014;38:132-7.
ALIF could have promoted endothelial injury 13. Blocher M, Mayer M, Resch H, Ortmaier R. Leriche-like syndrome
leading to thrombus formation. In addition, smoking as a delayed complication following posterior instrumentation of a
itself can promote hypercoagulability via unknown traumatic L1 fracture: a case report and literature review. Spine (Phila
mechanisms. [15] Pa 1976) 2015;40:1195-7.
14. Sonmez B, Yorukoglu Y, Williams BT. Traction injury in the
Authors’ contributions internal mammary artery. Report of a case and review the literature. J
Cardiovasc Surg (Torino) 1990;31:592-4.
Patient’s treatment and manuscript’s preparation: R. 15. Mitchell RN, Cotran RS. Hemodynamic disorders, thrombosis, and
Tummala shock. In: Cotran RS, Kumar V, Collins T, eds. Robbins pathological
Manuscript review: K. Ravakhah and A. Gupta basis of disease, 6th ed. Philadelphia: WB Saunders; 1999. p. 124-9.
16. Huang JH, Lee CH, Tsai TC, Peng SY. Perioperative thrombotic
Financial support and sponsorship occlusion of left external iliac artery during anterior lumbar interbody
None. fusion. Arch Orthop Trauma Surg 2008;128:1107-10.

158 Vessel Plus ¦ Volume 1 ¦ September 26, 2017