Lumbar Artery Injury Following Posterior Spinal Instrumentation for Scoliosis

: Vascular injuries are uncommon but potentially serious complications of spinal surgery. Lumbar artery lesion complicating posterior spinal instrumentation for scoliosis has been occasionally described. A 39-year-old woman with adult scoliosis was treated with correction and stabilization from T8 to L5 via a midline posterior approach. Transpedicular screws were inserted from levels L1 to L5 on the convex left side and at T11, T12, L4, and L5 on the concavity right side. Pedicle screws were not inserted from L2 to L4 on the right side due to difficulty identifying the pedicle channel with the probe. The instrumentation was completed with 2 hooks at T8 and T5 on the left side and 1 at T7. Five hours postoperatively, the patient suffered a hypotensive attack and her abdomen was distended. Her hemoglobin level was 4.5 g/dL. Hemodynamic stabilization was achieved with emergent therapy, including fluid resuscitation, blood, and plasma transfusion. An urgent contrast-enhanced abdominal computed tomography scan showed a large hematoma at the right retroperitoneum with active extravasation of contrast medium, but the source of bleeding was not detectable because of metallic artifacts. Immediate angiography demonstrated rupture of the third right lumbar artery. Selective microcoil embolization was performed with occlusion of the corresponding branch. The bleeding stopped and hemodynamic parameters were stable. No spinal cord impairment or muscle infarction occurred, and 1-year follow-up was uneventful. Lumbar artery injury should be considered as a complication after posterior spinal surgery for scoliosis and prompt diagnosis and intervention are required. Selective lumbar artery embolization is a safe and effective procedure to stop bleeding in hemodynamically stable patients after fluid resuscitation and blood transfusion.