An Unusual Case of Ureteral Perforation in Minimally Invasive Pedicle Screw Instrumentation: Case Report and Review of the Literature

Publication date: March 2018
Source:World Neurosurgery, Volume 111
Author(s): Edward Fomekong, Julien Pierrard, Etienne Danse, Bertrand Tombal, Christian Raftopoulos
BackgroundInjury of the ureter is a potentially devastating complication most often reported in gynecologic, colorectal, or vascular pelvic surgery or endoscopic procedures for ureteric diseases. We report a rare case of ureteral rupture occurring as a complication of percutaneous pedicle screw placement.Case DescriptionA 60-year-old man reported unbearable abdominal pain on the day after right L4-L5 transforaminal intervertebral fusion and percutaneous pedicle screw placement. A computer tomography workup showed contrast media extravasation outside the excretory system consistent with a left ureteral traumatic perforation. The patient underwent left nephrostomy and a double-J stent insertion and subsequently fully recovered. The ureter completely healed, enabling stent removal 5 months later.MethodsPubMed and EMBASE were screened for ureteral injury caused by posterior lumbar surgery.ResultsWe found 27 other reports with only 1 other case after minimally invasive transforaminal lumbar interbody.ConclusionsComplications 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 when performing minimally invasive procedures, in which, by definition, pedicles are concealed from direct visualization.



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