An unusual case of ureteral perforation in minimally invasive pedicle screw instrumentation and review of the literature.

Related Articles

An unusual case of ureteral perforation in minimally invasive pedicle screw instrumentation and review of the literature.

World Neurosurg. 2017 Dec 08;:

Authors: Fomekong E, Pierrard J, Danse E, Tombal B, Raftopoulos C

Abstract
BACKGROUND: and Importance: Injury of the ureter is a potentially devastating complication most often reported in gynecologic, colorectal, vascular pelvic surgery or endoscopic procedures for ureteric pathologies. We report a rare case of ureteral rupture occurring as a complication of percutaneous pedicle screw placement.
CLINICAL PRESENTATION: A 60-year old man complained of unbearable abdominal pain on the day after right L4-L5 transforaminal intervertebral fusion and percutaneous pedicle screw placement. A computer tomography workup reveals contrast media extravasation outside the excretory system consistent with a left ureteral traumatic perforation. He underwent left nephrostomy and a double-J stent insertion and subsequently fully recover. The ureter completely healed enabling a stent removal 5 month later.
REVIEW OF LITERATURE: PubMed and EMBASE were screened for ureteral injury caused by posterior lumbar surgery. We found a total of 27 other reports with only one other case following minimally invasive transforaminal lumbar interbody fusion (MI-TLIF).
CONCLUSION: Complications of minimally invasive pedicle screw placement are often described as dural tear of neurologic impairment. This report shows that unexpected side effects are still possible and spine surgeons should be aware especially while performing minimally invasive procedures in which by definition, pedicle are concealed to direct visualization.

PMID: 29229340 [PubMed - as supplied by publisher]

http://ift.tt/2C0NQyr