Median sacral artery injury during percutaneous mechanical disc decompression using Dekompressor®

Article information

Korean J Anesthesiol. 2014;67(Suppl):S60-S61

Publication date (electronic) : 2014 December 30

doi : https://doi.org/10.4097/kjae.2014.67.S.S60

Young Uk Kim ¹, Eun Young Chae ², Ji Hoon Lee ³, Chang Hee Lee ⁴, Young Ki Kim ⁴

¹Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

²Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

³Deparment of Neurosurgery, Gil Medical Center, Gachon University, Incheon, Korea.

⁴Department of Anesthesiology and Pain Medicine, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea.

Corresponding author: Young Ki Kim, M.D., Department of Anesthesiology and Pain Medicine, University of Ulsan College of Medicine, Gangneung Asan Hospital, 38, Bangdong-gil, Sacheon-myeon, Gangneung 210-711, Korea Tel: 82-33-610-3114, Fax: 82-33-610-3409, ykkim@gnah.co.kr

Disc decompression using the Dekompressor® (Stryker, Kalamazoo, MI, USA) is an effective procedure for treating patients with contained disc herniation [1,2,3,4,5]. Iatrogenic vascular injuries during lumbar disc decompression, although rare, are serious complications, that can be fatal without prompt diagnosis and management [5]. In this paper we present the case of a 23-year-old man with median sacral artery injury during lumbar disc decompression using the Dekompressor®. After the procedure, blood pressure decreased, and dizziness, and abdominal pain occurred in the recovery room. Abdomino-pelvic computed tomography (CT) without contrast medium showed a 7.5 cm sized hematoma in the left prevertebral space of the L5-S1 level. Leakage of contrast medium from the median sacral artery was noted by a contrast-enhanced CT scan (Fig. 1). Fortunately, the patient's vital signs were generally maintained by rapid transfusion. The next day, the patient underwent a repeat contrast-enhanced CT scan. There was no definite contrast extravasation, and the size of the retroperitoneal hematoma had decreased from 7.5 to 6 cm. The patient was treated by conservative management and recovered uneventfully.

Fig. 1

Contrast-enhanced CT images (A and B) show focal areas of high attenuation (white arrows) from the median sacral artery (black arrows) within the hematoma, a finding that represents an active bleeding.

References

1. Han SS, Sim SE, Kim YH, Lee EH, Joh JY, Kim JY, et al. Clinical outcomes of percutaneous lumbar discectomy using Dekompressor. Korean J Pain 2005;18:187–191.

2. Kim YH, Gu MS, Lee EH, Joh JY, Han SS, Lee CJ, et al. Percutaneous cervical discectomy using Dekompressor. Korean J Pain 2005;18:271–274.

3. Cho OG, Kim C, Han KR, Lee HH, Cho HW. Percutaneous discectomy of herniated intervertebral disc with a Dekompressor. Korean J Pain 2005;18:192–197.

4. Lemcke J, Al-Zain F, Mutze S, Meier U. Minimally invasive spinal surgery using nucleoplasty and the Dekompressor tool: a comparison of two methods in a one year follow-up. Minim Invasive Neurosurg 2010;53:236–242. 21302191.

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