Diagnosis and treatment of left ureteral injury as a rare complication of oblique lumbar interbody fusion surgery: a case report and literature review

Abstract

Background: Oblique lumbar interbody fusion (OLIF) surgery has been performed as a minimally invasive lateral lumbar fusion technique in recent years. Reports of operative complications of OLIF are limited, and there are fewer reports of ureteral injuries.

Case presentation: A 62-year-old Chinese woman diagnosed with "lumbar spondylolisthesis (L4 forward slip, I degree)" underwent OLIF treatment. The surgical decompression process was smooth, and the cage was successfully placed. After the expansion sleeve of OLIF was removed, clear liquid continuous outflow from the peritoneum was found. The patient was diagnosed with a ureteral injury. The urological surgeon expanded the original incision, and left ureteral injury anastomosis and ureteral stent implantation were performed. The patient was changed to the prone position and a percutaneous pedicle screw was placed in the corresponding vertebral body. The patient was indwelled with a catheter for 2 weeks, and regular oral administration of levofloxacin to prevent urinary tract infection. After 2 months, the double J tube was removed using a cystoscope. One year after surgery, the symptoms of lumbar back were significantly improved, and there were no urinary system symptoms. However, the patient needed an annual left ureter and kidney B-ultrasound.

Conclusion: Ureteral injury is a rare complication and is easily missed in OLIF surgery. If the diagnosis is missed, the consequences can be serious. Patients should undergo catheterization before the operation and hematuria should be observed during the operation. We emphasize the careful use of surgical instruments to prevent intraoperative complications. In addition, after withdrawing the leaf in the operation, it is necessary to carefully observe whether a clear liquid continues to leak. If ureteral injury is found, one-stage ureteral injury repair operation should be performed to prevent ureteral stricture.

Keywords: Case report; Complications; Oblique lumbar interbody fusion (OLIF); Ureteral injury.

Fig. 1

Preoperative radiography lumbar vertebrae, lateral position, overextension (a), MRI (b) and CT (c) revealed L4 vertebral body slip forward (I degree) and L4/5 lumbar spondylolisthesis

Fig. 2

Photos of left ureter repair during surgery and postoperative review imaging. a Showed that hematuria was found in the catheter. b Showed that the ureteral stent was inserted into the left ureter during the operation. c Showed that the left ureter was repaired during surgery. d Showed that the intraoperative X-ray indicated the height recovery of the intervertebral disc and the left ureter double J tube was in good position. e Showed that a good fixation position within 1 year after surgery

Fig. 3

The adjacent relationship of the structures under the OLIF approach