How to manage a ureteral injury after anterior lumbar spine interbody fusion surgery.

Autor: Leroy HA; CHU Lille, Department of Neurosurgery, F-59000 Lille, France; AO Spine, Chairman for France, 7270 Davos, Switzerland. Electronic address: henriarthurleroy@gmail.com., De Buck P; Lille Catholic Hospitals and Lille Catholic University, F-59000 Lille, France., Marcq G; CHU Lille, Department of Urology, Claude Huriez Hospital, F-59000 Lille, France; UMR9020-U1277 - CANTHER - Cancer Heterogeneity Plasticity and Resistance to Therapies, Univ. Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, F-59000 Lille, France., Assaker R; CHU Lille, Department of Neurosurgery, F-59000 Lille, France.
Jazyk: angličtina
Zdroj: Neuro-Chirurgie [Neurochirurgie] 2023 Nov; Vol. 69 (6), pp. 101503. Date of Electronic Publication: 2023 Sep 27.
DOI: 10.1016/j.neuchi.2023.101503
Abstrakt: Background: Anterior lumbosacral interbody fusion (ALIF) surgery is a predominant approach used in various indications such as treating discogenic back pain, spondylolisthesis, degenerative lumbar scoliosis, intervertebral foraminal stenosis, or spondylolysis. In comparison with posterior conventional approach, ALIF surgery has several advantages: direct access to the spine without muscle dissection, reduced blood loss, decreased postoperative pain, and improved fusion rates. Rare complications following ALIF surgery need to be reported, therefore the authors present an uncommon case of a ureteral injury diagnosed early after surgery and its management.
Management of a Urinoma: Herein, we present a case of a 35-year-old man who presented with abnormal abdominal pains 4 days after ALIF surgery. He was diagnosed with a distal left iatrogenic ureteral fistula on a contrast enhanced CT. After the initial endoscopic approach with double J stent and urinary catheter drainage insertion had failed, the injury was finally treated with ureterovesical reimplantation. At the last follow-up, the patient did well without any clinical or biological urinary sequelae after this grade IIIb complication on the Clavien Dindo Scale.
Conclusion: Although ureteral lesions during ALIF surgery are extremely uncommon, surgeons must be cautious when dissecting the retroperitoneal area. A methodical identification of the ureter might guarantee the security of each surgery, especially for patients who have undergone previous abdominal interventions.
(Copyright © 2023 Elsevier Masson SAS. All rights reserved.)
Databáze: MEDLINE
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