Name:
FOCUS25824video3
Description:
FOCUS25824video3
Thumbnail URL:
https://cadmoremediastorage.blob.core.windows.net/6a4c0bf6-9cd6-42ad-99d6-e4929c41ec83/videoscrubberimages/Scrubber_0.jpg?sv=2019-02-02&sr=c&sig=jjfd3nShw%2BElztRDPdxw7MMMIBpcnFgTP6agF%2BvDdRk%3D&st=2026-05-13T19%3A51%3A49Z&se=2026-05-13T23%3A56%3A49Z&sp=r
Duration:
T00H04M00S
Embed URL:
https://stream.cadmore.media/player/6a4c0bf6-9cd6-42ad-99d6-e4929c41ec83
Content URL:
https://cadmoreoriginalmedia.blob.core.windows.net/6a4c0bf6-9cd6-42ad-99d6-e4929c41ec83/3. 25-27.mp4?sv=2019-02-02&sr=c&sig=VGkwVOFszog2MuVsyDrI1b0%2BMajBYrhDmxBhtndLaVs%3D&st=2026-05-13T19%3A51%3A49Z&se=2026-05-13T21%3A56%3A49Z&sp=r
Upload Date:
2025-12-03T00:00:00.0000000
Transcript:
Language: EN.
Segment:0 .
SPEAKER: Catastrophic complications
SPEAKER: of lateral spine surgery. Vascular injuries. A patient in her late 50s with a long-standing history of lumbar back pain and radiculopathy exhausted conservative treatment without improvement. Imaging revealed grade 1 spondylolisthesis at L4–5, associated with neural compression. After evaluation, the surgical team recommended left-sided lumbar interbody fusion to decompress the nerve roots and stabilize the spine.
SPEAKER: Preoperative imaging played a crucial role in surgical planning. MRI provides information about the degree of neural compression, while CT and MRI should be studied to understand the great vessel anatomy in relationship to the surgical corridor. Patient-specific anatomy should be studied on preoperative imaging, including the presence of any coronal deformity, the presence of lateral osteophytes, the location of the great vessels in relationship to the surgical corridor, and the position of the psoas relative to the vertebral body.
SPEAKER: L4–5 LLIF was selected to decompress the neural foramen and stabilize the spine. However, the procedure comes with inherent risks, including lumbar plexus and vascular injuries. Use of intraoperative EMG monitoring, fluoroscopic navigation, and careful surgical technique are important in risk mitigation. The surgical approach involves careful positioning and retroperitoneal dissection to access the L4–5 disc space.
SPEAKER: Despite meticulous planning, retractor placement resulted in an inadvertent injury to the left common iliac vein, causing rapid blood loss. The surgical team acted immediately to control the hemorrhage, resulting in intraoperative mortality despite resuscitation efforts. Despite rapid intervention, the severity of the vascular injury resulted in fatal hemodynamic instability. This case highlights the gravity of vascular injuries in the setting of LLIF approaches, which can be catastrophic.
SPEAKER: This highlights the importance of vascular injury avoidance with appropriate preoperative planning and surgical technique. Vascular injuries remain a significant challenge in LLIF with the potential for severe consequences. This case emphasizes the importance of understanding the patient's vascular anatomy in relationship to the surgical corridor. Careful retractor placement is critical to avoid excessive retraction or pressure on vascular structures.
SPEAKER: It is important to dock on bone and, when opening the retractor, to sweep the ventral structures away. The anterior shim should be placed slowly under direct visualization to ensure that no vessel is caught underneath the retractor blade and shim. Vascular injuries can be catastrophic in the setting of LLIF.
SPEAKER: Prevention is key. Strategies to prevent vascular injuries include the following. Choose the appropriate approach side with a safe surgical corridor away from dorsally displaced or stuck vessels, as seen on preoperative imaging. Ensure that the patient is not rotated on anteroposterior fluoroscopy throughout the procedure. Use fluoroscopic guidance when working on the contralateral spine, when you cannot directly visualize your instrument, to minimize risk of contralateral vascular injury.
SPEAKER:
Form Title Download
Form Title Bookmark
Form Title Share
Form Title Cite
