Our Summary

This research paper discusses a rare but potentially dangerous complication that can occur during a specific type of back surgery called a lumbar microdiscectomy. In this particular case, a patient who had this surgery experienced an injury to one of their arteries, the inferior mesenteric artery. After the surgery, the patient showed signs of low blood pressure and fast heart rate, also known as hypotension and tachycardia. These complications were successfully treated with a procedure called endovascular embolization.

The researchers suggested that the way the patient was positioned during the surgery (face-down or prone) might have contributed to this artery injury. To reduce the risk of such complications in future, they recommended using a specially designed surgical table called the Jackson table, instead of a standard one. They also stressed the importance of carefully examining the patient’s abdomen and pelvis before surgery.

FAQs

  1. What is the risk of vascular injury during a lumbar microdiscectomy?
  2. How can vascular injuries be managed during a lumbar microdiscectomy operation?
  3. What precautions can be taken to prevent vascular injuries during a lumbar microdiscectomy?

Doctor’s Tip

A doctor may advise a patient undergoing microdiscectomy to discuss the potential risks of iatrogenic vascular injury with their surgeon. They may also recommend making sure the surgical team is experienced in performing the procedure and taking precautions such as using the Jackson table and thoroughly inspecting the abdomen and pelvis before surgery to minimize the risk of complications.

Suitable For

Patients who are typically recommended for microdiscectomy are those who have a herniated disc in the lumbar region causing symptoms such as leg pain, numbness, weakness, or tingling. These symptoms are often due to pressure on the spinal nerves caused by the herniated disc. Patients who have not experienced relief from conservative treatments such as physical therapy, medications, or injections may be candidates for microdiscectomy surgery. It is important for patients to undergo a thorough evaluation by a spine specialist to determine if microdiscectomy is the appropriate treatment option for their condition.

Timeline

Before microdiscectomy:

  • Patient experiences symptoms of lumbar disc herniation such as back pain, leg pain, and numbness
  • Patient undergoes diagnostic tests such as MRI or CT scan to confirm the diagnosis
  • Patient consults with a neurosurgeon or orthopedic surgeon to discuss treatment options, including microdiscectomy

After microdiscectomy:

  • Patient undergoes surgery to remove the herniated disc material pressing on the nerve root
  • Patient is placed in a prone position during the operation
  • Patient experiences symptoms of hypotension and tachycardia in the recovery room
  • Patient is diagnosed with inferior mesenteric artery injury
  • Patient undergoes endovascular embolization to manage the vascular injury
  • Surgeons recommend using the Jackson table and thoroughly inspecting the abdomen and pelvis prior to future operations to prevent similar complications.

What to Ask Your Doctor

  1. What are the potential risks and complications associated with microdiscectomy, including the risk of vascular injury?

  2. How often do complications such as vascular injury occur during microdiscectomy procedures?

  3. What steps will be taken to prevent and monitor for vascular injury during the surgery?

  4. What are the symptoms of vascular injury that I should be aware of after the surgery?

  5. How will vascular injury be diagnosed and treated if it occurs during or after the microdiscectomy?

  6. Are there any specific precautions or considerations that should be taken into account during the surgery to minimize the risk of vascular injury?

  7. Are there any alternative treatment options to microdiscectomy that may have a lower risk of vascular injury?

  8. How experienced is the surgical team in performing microdiscectomy procedures and managing any potential complications that may arise?

  9. What is the expected recovery and rehabilitation process following a microdiscectomy, and how will any complications, including vascular injury, affect this process?

  10. Are there any specific lifestyle changes or precautions that I should take after the surgery to reduce the risk of complications, including vascular injury?

Reference

Authors: Aljohani AK, Khalid Bin Yunus M, Fallatah AA, Kheder OM, Almolki KS, Alawad H, Talal Halawani R, Abdelaziz AA, Sherif A. Journal: Cureus. 2023 Aug 5;15(8):e42998. doi: 10.7759/cureus.42998. eCollection 2023 Aug. PMID: 37671208