Depth labeled lumbar disc forceps for safe lumbar disc surgery: Our experience with 405 patients

Abstract

Depth labeled lumbar disc forceps for safe lumbar disc surgery: Our experience with 405 patients Aim : Injury of intraabdominal structures by rupturing the anterior longitudinal ligament is a known complication of diskectomy. Despite its very low incidence, it has a high mortality. Although various minimally invasive methods are defined for discectomy, no significant reduction in this complication has been achieved. Positioning of the patient, aggressive discectomy, and deep-seated use of disc forceps are important risk factors. The aim of this study is to share our experience with modified instruments to minimize the risk of vascular and visceral injury during discectomy in surgically treated 405 patients with lumbar disc herniation. Materials and Methods: We routinely perform preoperative depth measurements at the level of lumbar disc herniations for the patients undergoing lumbar disc surgery and check the neighborhood with the prevertebral structures. During the operation, we perform discectomy with custom disc forceps that were labeled with centimeter measurements in accordance with these lengths. We performed discectomy on 405 patients using these forceps between January 2015 and May 2021. Results: In this retrospective study, disc depth measurements differed according to disc levels and gender. Disc depth was longer in males at all lumbar disc levels. Conclusion: It is very important to avoid vascular and visceral injuries for spinal surgeons. For this reason, we believe that knowing the safe preoperative discectomy depth and area and using centimeter-labeled disc forceps is the best method to prevent such complications.

Keywords

• vascular injury
• bowel injury
• ureter injury
• safe discectomy
• depth labeled disk forceps

References

1. 1. Anda SA, Aakhus S, Skaanes KO, Sande E, Schrader H. Anterior perforations in lumbar discectomies. A report of four cases of vascular complications and a CT study of the prevertebral lumbar anatomy. Spine. 1991;16:54–60.
2. 2. Antar V, Baran O, Kelten B, Atcı I.B, Yılmaz H, Katar S, et al. Morphometric Analysis of Lumbar Disc Space in the Turkish Population and Safe Discectomy Distance in Lumbar Disc Surgery. Turk Neurosurg, 2016; 27(4):603-9. doi: 10.5137/1019-5149.JTN.16871-15.0.
3. 3. Birkeland IW, Taylor TKF. Bowel injuries coincident to lumbar disk surgery: a report of four cases and review of literature. J Trauma 1970; 10:163–8.
4. 4. Birkeland IW, Taylor TKF. Major vascular injuries in lumbar disc surgery. J Bone Joint Surg. 1969; 51B (1):4–19.
5. 5. Bolesta MJ. Vascular injury during lumbar diskectomy associated with peridiskal fibrosis: case report and literature review. J Spinal Disord. 1995; 8:224–7.
6. 6. Brewster DC, May ARL, Darling RC, Abbott WM, Moncure AC. Variable manifestations of vascular injury during lumbar disc surgery. Arch Surg. 1979; 114:1026–1030.
7. 7. Canaud L, Hireche K, Joyeux F, D'Annoville T, Berthet JP, Marty-Ané C, et al. Endovascular repair of aorto-iliac artery injuries after lumbar-spine surgery. Eur J Vasc Endovasc Surg. 2011;42:167–71.
8. 8. de Quintana-Schmidt C, Clavel-Laria P, Bartumeus-Jené F. Ureteral injury after posterior lumbar surgery. Case report. Neurocirugia (Astur), 2011: 22(2);162–166.

9. 9. Demirkesen O, Tunc B, Ozkan B. A rare complication of lumbar disk surgery: ureteral avulsion. Int Urol Nephrol, 2006; 38(3–4): 459–461.
10. 10. Döşoğlu M, Iş M, Pehlivan M, Yıldız HK. Nightmare of lumbar disc surgery: iliac artery injury. Clin Neurol Neurosurg. 2006; 108:174–7.
11. 11. Erkut B, Unlü Y, Kaygin MA, Çolak A, Erdem AF. Iatrogenic vascular injury during to lumbar disc surgery. Acta Neurochir. 2007; 149:511–6.
12. 12. Goel A, Kumar P, Bahadur R. Abdominal Vascular Injury During Posterior Lumbar Discectomy, Experience from Three Cases and Review of Literature. Spine. 2019; 44(20);E1227–E1230. doi: 10.1097/BRS.0000000000003100.
13. 13. Goodkin R, Laska LL. Vascular and visceral injuries associated with lumbar disc surgery: medicolegal implications. Surg Neurol. 1998;49:358–72.
14. 14. Hernández-Perez PA, Prinzo-Yamurri H. Analysis of the lumbar discectomy complications. Neurocirugia. 2005; 16(5):419-26.
15. 15. Inamasu J, Guiot B. H. Vascular injury and complication in neurosurgical spine surgery. Acta Neurochir (Wien). 2006; 148:375–387.
16. 16. Ioannis Siasios, Kunal Vakharia, Asham Khan, Joshua E. Meyers, Samantha Yavorek, John Pollina, et al. Bowel injury in lumbar spine surgery: a review of the literatüre J Spine Surg. 2018; 4(1):130-137.
17. 17. Kashani FO, Mousavi SM. Total ureteral avulsion leading to early nephrectomy as a rare complication of simple lumbar discectomy; a case report. SICOT J. 2015; 1: 30. doi: 10.1051/sicotj/2015031
18. 18. Keskin M, Serin KR, Genc FA, Aksoy M, Yanar F, Kurtoğlu M. Iatrogenic major vascular injury during lumbar discectomy: report of three cases. Turk Neurosurg. 2013;23:385–8.
19. 19. Kramer J. Intervertebral disc disease. Causes, diagnosis, treatment and prophylaxis. New York: Thieme Medical Publishers Inc.; 1990. p. 18.
20. 20. Leavens ME, Bradford FK. Ruptured intervertebral disc. Report of a case with a defect in the anterior annulus fibrosus. J Neurosurg. 1953; 10: 544–546.
21. 21. Linton RR, White PD. Arteriovenous fistula between the right common iliac artery and the inferior vena cava: report of a case of its occurrence following an operation for a ruptured intervertebral disc with cure by operation. Arch Surg. 1945;50:e13.
22. 22. María Jose Cases-Baldó, Victor Soria-Aledo, Joana Aina Miguel-Perello, Jose Luis Aguayo-Albasini, Maria Remedios Hernández. Unnoticed small bowel perforation as a complication of lumbar discectomy. The Spine Journal. 2011. doi: 10.1016/j.spinee.2010.10.018
23. 23. Nilsonne U., Hakelius A. on vascular injury in lumber disc surgery. Acta Orthop Scand. 1965; 35:229-237.
24. 24. Papadoulas S, Konstantinou D, Kourea HP, Kritikos N, Haftouras N, Tsolakis JA. Vascular injury complicating lumbar disc surgery. A systematic review. Eur J Vasc Endovasc Surg. 2002; 24:189–95.
25. 25. Prabhakar H, Bithal PK, Dash M, Chaturvedi A. Rupture of aorta and inferior vena cava during lumbar disc surgery. Acta Neurochir (Wien). 2005; 147: 327–329. Doi: 10.1007/s00701-004-0405-2
26. 26. Ríos González E, Ramón de Fata Chillón F, Tabernero Gómez A, Núñez Mora C, Hidalgo Togores L, de la Peña Barthel JJ. Iatrogenic injury of the lumbar ureter and iliac vessels after lumbar discectomy: urologic treatment using kidney autotransplantation. Actas Urol Esp, 2002; 26(7):504–508.
27. 27. Sahinoglu M, Arun O, Orhan A, Nayman A, Calısır A, Böcü Y, et al. Iliac Artery Injury During Lumbar Disc Hernia Surgery. World Neurosurg. 2019; 125:347-351.
28. 28. Schwartz AM, Brodkey JS. Bowel perforation following microsurgical discectomy. A case report. Spine. 1989;14:104–6.
29. 29. Shakir AJ, Paterson HM. Small Bowel Perforation - an Unusual Complication of Microdiscectomy : a Case Report. Acta Chir Belg, 2011; 111: 36-37.
30. 30. Shaw ED, Scarbrough JT, Beals RK. Bowel injury as a complication of lumbar discectomy. A case report and review of the literature. J Bone Joint Surg Am. 1981;63:478–80.
31. 31. Siu-Leung Yip , Siu-Bon Woo , Tik-Koon Kwok , Kan-Hing Mak. Nightmare of Lumbar Diskectomy : Aorta Laceration. Spine. 2011; 36(26)E1758–E1760. doi: 10.1097/BRS.0b013e3182194e1c
32. 32. Skippage P, Raja J, McFarland R, Belli AM. Endovascular repair of iliac artery injury complicating lumbar disc surgery. Eur Spine J. 2008;17 (Suppl 2):228–31.
33. 33. Smith DW, Lawrence BD. Vascular complications of lumbar decompression, laminectomy and foraminotomy. Spine. 1991; 16: 387–390.
34. 34. Smith EB, Hanigan WC. Injuries to the intraabdominal viscera associated with lumbar disk excision. In: Tarlov EC, ed. Neurosurgical topics: complications of spinal surgery. Park Ridge, IL. American Association of Neurological Surgeons, 1991:41–9.
35. 35. Smith RA, Estridge MN. Bowel perforation following lumbar-disc surgery. J Bone Joint Surg Am. 1964; 46:826–32.
36. 36. Szolar DH, Preidler W, Steiner H, Riepl T, Flaschka G, Stiskal M, et al. Vascular complications in lumbar disc surgery: report of four cases. Neuroradiology. 1996; 38:521–525.
37. 37. Torun F, Tuna H, Deda H. Abdominal vascular injury during lumbar disc surgery: report of three cases. Ulus Travma Acil Cerrahi Derg. 2007; 13:165–7.
38. 38. Trinchieri A, Montanari E, Salvini P, Berardinelli L, Pisani E. Renal autotransplantation for complete ureteral avulsion following lumbar disk surgery. J Urol. 2001; 165: 1210–1211.
39. 39. Tsai YD, Yu PC, Lee TC, Chen HS, Wang SH, Kuo YL. Superior rectal artery injury following lumbar disc surgery. J Neurosurg (Spine 1). 2001;95:108–10.
40. 40. Turunc T, Kuzgunbay B, Gul U, Ozkardes H. Ureteral avulsion due to lumbar disc hernia repair. Can J Urol, 2010; 17(6): 5478–5479.
41. 41. van Zitteren M, Fan B, Lohle PN, de Nie JC, Malefijt JW. A shift toward endovascular repair for vascular complications in lumbar disc surgery during the last decade. Ann Vasc Surg. 2013; 27:810–9