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Vascular Injury in Thoracolumbar Spinal Surgeries and Role of Angiography in Early Diagnosis and Management

Kim, Hak Sun PhD*; Chong, Hyon Su MD*; Nanda, Ankur MD*; Park, Jin Oh PhD*; Moon, Seong Hwan PhD*; Lee, Hwan Mo PhD*; Kim, Ho Joong MD*; Park, Chun Kun PhD; Park, Ye Soo PhD; Lee, Suk Ha PhD§; Moon, Eun Su MD*

doi: 10.1097/BSD.0b013e3181b63f33
Original Articles

Study Design A retrospective outcomes study.

Objective To stress on the importance of early diagnosis with the help of angiography and proper treatment of vascular injuries occurring during thoracolumbar surgeries and to report our results.

Summary of Background Data Vascular injury is a rare but dangerous complication that can develop during thoracolumbar surgeries and if not treated properly then it can lead to severe complications including the death of the patient.

Methods The patients included in this study were the ones who were suspected to have a possible vascular injury after a thoracolumbar surgery. Contrast enhanced computed tomography was performed for patients having clinical signs suggesting vascular injury. Among these patients, who were suspected to have active bleeding and major vessel injury on computed tomography were further subjected to angiography.

Results Of the 10 cases included in the study, vascular injury was identified to be arterial in origin in 8 cases and venous in 3 cases. Among the 8 cases of identified arterial injury, angiography was performed in 4 cases, of which 3 were found to have active bleeding and were subjected to immediate intervention. Of the 4 cases in which angiography was not performed, 3 of them expired at variable postoperative periods. Complications developed in total 5 cases including 3 cases of mortality, 1 case of infection, and 1 case of cauda equina syndrome.

Conclusions The vascular injuries during thoracolumbar spinal surgeries need immediate and aggressive treatment. In arterial injuries, we can prevent serious consequences by subjecting the patient to an angiography as early as possible followed by a therapeutic embolization. In contrast, for venous injuries if hemostasis has been confirmed, then an immediate intervention may not be always required.

*Department of Orthopedic Surgery, Yonsei University College of Medicine

Department of Neurosurgery, The Catholic University of Korea

Department of Orthopedic Surgery, Hanyang University College of Medicine

§Department of Orthopedic Surgery, Kunkuk University College of Medicine, Seoul, South Korea

Reprints: Eun Su Moon, MD, Department of Orthopedic Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, 712 Eonjuro, Gangnam-gu, Seoul, South Korea (e-mail:

Received for publication February 25, 2009

accepted July 3, 2009

This study was approved by the review board of the institution.

No benefits to the authors or institution have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

© 2010 Lippincott Williams & Wilkins, Inc.