Case Report
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Nov 26, 2022; 10(33): 12345-12351
Published online Nov 26, 2022. doi: 10.12998/wjcc.v10.i33.12345
Segmental artery injury during transforaminal percutaneous endoscopic lumbar discectomy: Two case reports
Wan-Jae Cho, Ki-Won Kim, Hyung-Youl Park, Bo-Hyoung Kim, Jun-Seok Lee
Wan-Jae Cho, Ki-Won Kim, Bo-Hyoung Kim, Department of Orthopedic Surgery, Yeouido St. Mary’s Hospital, College of Medicine, Catholic University of Korea, Seoul 07345, South Korea
Hyung-Youl Park, Jun-Seok Lee, Department of Orthopedic Surgery, Eunpyeong St. Mary’s Hospital, College of Medicine, Catholic University of Korea, Seoul 03312, South Korea
Author contributions: Lee JS conceived the idea of the case report; Kim KW, Park HY, and Kim BH prepared the figures and collected the data; Cho WJ wrote the manuscript; All authors read and approved the final manuscript.
Informed consent statement: Both patients included in the present case series gave their consent prior to study inclusion.
Conflict-of-interest statement: All authors have no conflicts of interest to declare.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jun-Seok Lee, MD, PhD, Professor, Department of Orthopedic Surgery, Eunpyeong St. Mary’s Hospital, College of Medicine, Catholic University of Korea, No. 1021 Tongil-Ro, Eunpyeong-gu, Seoul 03312, South Korea. junband@naver.com
Received: July 23, 2022
Peer-review started: July 23, 2022
First decision: October 12, 2022
Revised: October 19, 2022
Accepted: November 2, 2022
Article in press: November 2, 2022
Published online: November 26, 2022
Processing time: 123 Days and 7.1 Hours
Abstract
BACKGROUND

Since Kambin experimentally induced arthroscopy to treat herniated nucleus pulposus, percutaneous endoscopic lumbar discectomy (PELD) has been developed. The branch of the segmental artery around the neural foramen may be damaged during PELD using the transforaminal approach. We report 2 rare cases in which segmental artery injury that occurred during PELD was treated with emergency embolization.

CASE SUMMARY

In case 1, a 31-year-old man was transferred to our emergency department with left lower quadrant abdominal pain after PELD at a local hospital. Lumbar spine magnetic resonance imaging after the surgery showed a hematoma of the left retroperitoneal area and the psoas muscle area. Under suspicion of vascular injury, arteriography was performed. Pseudoaneurysm and blood leakage from the left 4th lumbar segmental artery into the abdominal cavity were identified. Emergency transarterial embolization was performed using fibered microcoils for bleeding of the segmental artery. In case 2, a 75-year-old woman was transferred to our emergency department with low blood pressure, right flank pain, and drowsy mental status after PELD at a local hospital. When the patient arrived at the emergency room, the blood pressure decreased from 107/55 mmHg to 72/47 mmHg. Low blood pressure persisted. Under suspicion of vessel injury, arteriography was performed, and the right 4th lumbar segmental artery rupture was confirmed. Emergency transarterial embolization was performed for bleeding of segmental artery.

CONCLUSION

We were able to find the bleeding focus by angiography and treat the injury of the segmental artery successfully through emergency transarterial embolization.

Keywords: Percutaneous endoscopic lumbar discectomy; Segmental artery injury; Transarterial embolization; Angiography; Case report

Core Tip: The branch of the segmental artery around the neural foramen may be damaged during percutaneous endoscopic lumbar discectomy using the transforaminal approach. When segmental artery rupture is suspected, angiography is helpful in finding the bleeding focus, and emergency embolization is considered an effective treatment method. In our 2 cases, clear bleeding focus was found by angiography, and the bleeding was controlled successfully through emergency transarterial embolization.