Ureteral injury after posterior lumbar discectomy with interbody screw fixation

Abstract

We report a case of iatrogenic ureteral injury secondary to L5 laminectomy and microdiscectomy with L5-S1 bone graft with posterior lumbar interbodyfusion using presacral cancellous screw fixation, managed by initial ureteral stent placement and subsequent Boari bladder flap repair. A 33-year-old woman underwent L5 laminectomy and microdiscectomy with L5-S1 bone graft with posterior lumbar interbody fusion using presacral cancellous screw fixation. On postoperative day 10, she developed lower abdominal pain, vomiting and fever. Ultrasonogram and contrast-enhanced CT demonstrated a large pelvic urinoma secondary to a right lower ureteric injury. This was managed initially by ureteral stent placement and subsequent Boari bladder flap repair. Ureteral injury following spinal surgery is a rare surgical complication with significant morbidity and mortality. A high index of suspicion is essential for early appropriate management and renal salvage.

Figure 1

X-ray on admission demonstrating nasogastric tube and presacral cancellous screw in situ.

Figure 2

Contrast-enhanced CT showing large pelvic urinoma (arrow) and right hydroureteronephrosis.

Figure 3

Contrast-enhanced CT showing large pelvic urinoma (larger arrow) displacing the bladder with Foley's balloon (small arrow).

Figure 4

Right retrograde ureterogram (A) and ureteric catheter (B) demonstrating complete cut-off at S1–S2 level.

Figure 5

(A and B) Right DJ ureteral stent in place (anteroposterior and lateral views).