Department of Interventional Radiology and Vascular Surgery, Peking University Third Hospital, Beijing, China.
Spine (Phila Pa 1976). 2012 Dec 1;37(25):E1594-7. doi: 10.1097/BRS.0b013e318272fd3d.
Case report.
To describe a unique case of iliac pseudoaneurysm-complicated lumbar disc surgery performed 13 years ago.
Major vascular injury is an unusual but life-threatening complication of lumbar disc surgery. If a major vascular injury is unnoticed, the late complications, pseudoaneurysm, may be diagnosed years after primary lumbar disc surgery. Pseudoaneurysm can lead to compression of adjacent neurovascular structures; however, erosion into the adjacent vertebras and presentation with symptoms of nerve root irritation are rare.
The patient was a 54-year-old man who presented with pain and numbness in right hip and leg. Examination was normal. A plain radiograph showed destruction of the fourth and fifth lumbar vertebras. Magnetic resonance image showed a retroperitoneal mass eroding into the adjacent vertebras. The mass was primarily misdiagnosed as a neoplasm and a percutaneous needle biopsy was recommended. Before puncture, the computed tomographic angiogram confirmed it to be a pseudoaneurysm of left common iliac artery. Then, implantation of a covered stent was undergone.
After implantation of a covered stent, the symptoms were relieved immediately. At the 12-month follow-up, the patient remained asymptomatic, and a computed tomographic angiogram revealed progressive shrinkage of the mass and significant healing of the eroded vertebras.
As an unusual complication of lumbar disc surgery, iliac pseudoaneurysm can present with radiating pain even after 13 years and erode into the adjacent vertebras producing appearances mimicking a tumor. For mass located anterior to vertebras, the percutaneous biopsy must be cautiously performed, and a contrast-enhanced computed tomographic scan is necessary.
病例报告。
描述 13 年前行腰椎间盘手术并发髂假性动脉瘤的独特病例。
大血管损伤是腰椎间盘手术罕见但危及生命的并发症。如果大血管损伤未被发现，假性动脉瘤等迟发性并发症可能在原发性腰椎间盘手术后数年才被诊断出来。假性动脉瘤可导致邻近的神经血管结构受压；然而，侵蚀到相邻的椎体并出现神经根刺激症状则较为罕见。
患者为 54 岁男性，表现为右侧髋部和腿部疼痛和麻木。检查正常。平片显示第四和第五腰椎椎体破坏。磁共振成像显示腹膜后肿块侵蚀相邻椎体。该肿块最初被误诊为肿瘤，并建议进行经皮穿刺活检。在穿刺前，计算机断层血管造影术证实为左侧髂总动脉假性动脉瘤。然后，进行了带膜支架植入术。
植入带膜支架后，症状立即缓解。12 个月随访时，患者无症状，计算机断层血管造影显示肿块逐渐缩小，侵蚀的椎体明显愈合。
作为腰椎间盘手术的一种罕见并发症，髂假性动脉瘤即使在 13 年后也可能出现放射痛，并侵蚀到相邻的椎体，产生类似于肿瘤的表现。对于位于椎体前方的肿块，经皮活检必须谨慎进行，且需要进行增强计算机断层扫描。
