This case study revolves around an adult who underwent anterior and posterior decompression and fusion at L4-S1. During the surgical procedure, there was no documentation indicating that the ureter had been located or isolated.
Following surgery, the patient exhibited red blood cells in their urine and an increase in creatinine levels. Despite these alarming signs, no further investigation was conducted.
The patient was discharged but later returned with lower left quadrant (LLQ) pain. A CT scan revealed a urethral/hematoma in the retroperitoneal space, compressing the iliac vein and causing deep vein thrombosis (DVT). Upon exploration, it was discovered that the patient’s ureter had been transected during surgery, necessitating stent placement.
This case seeks expert opinion on the standard of care provided during this spinal surgery.
Questions to the expert and their responses
How often do you perform anterior fusions?
As a board-certified, fellowship-trained orthopedic spinal surgeon actively practicing, I am well-versed in this area. I conduct over 300 spine surgeries annually, employing various anterior approaches such as ALIF, OLIF, & XLIF.
At what point during the procedure should the ureter be identified?
Identification of the ureter is crucial during any surgical procedure involving its proximity to prevent potential damage.
Postoperatively, what do red blood cells in the urine and creatinine elevation suggest and how should they be managed?
Red blood cells in urine postoperatively and elevated creatinine levels could indicate acute kidney injury (AKI), possibly resulting from a ureteral leak following an anterior approach. To diagnose the issue quickly, a CT scan with IV contrast should be performed immediately.
Have you ever reviewed a similar case? If yes, please explain.
Yes, I have reviewed one similar case involving ureteral injury after an anterior approach. Post-operative care requires vigilance for potential complications, prompt recognition, and immediate management.
About the expert
This expert is a seasoned orthopedic spine surgeon with over 15 years of experience and an extensive educational background, including fellowships in spine surgery and pediatric orthopedics. They are board-certified in orthopedic surgery, have contributed significantly to academia through research and publications related to their field, and have taught orthopedic surgery techniques globally. Currently, they serve as an attending orthopedic spine surgeon at a hospital and surgical center while also being the founder and an orthopedic spine surgeon at a separate spine and joint surgical center.
About the author