Iliac Artery Perforation Following Lumbar Discectomy With Microsurgical Carbon Dioxide Laser: A Report of a Rare Case and Discussion on the Treatment

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Abstract

Study Design.

Case report.

Objective.

We present a rare complication of iliac artery perforation during lumbar disc surgery using a microscope-attached carbon dioxide laser system.

Summary of Background Data.

Since 1991, the authors have used a carbon dioxide laser to ablate disc fragment and osteophyte during lumbar microdiscectomy as a safe and convenient alternative to the scalpel and rongeur. We report the first case of a major vascular injury due to carbon dioxide laser.

Methods.

A 42-year-old female patient underwent a right L5–S1 microdiscectomy for paramedian disc herniation. During the discectomy, the carbon dioxide laser was operated in continuous mode and irradiated anteriorly to ablate the intervertebral disc. High-energy (20 W) laser radiation caused perforation of a major vessel.

Results.

Emergent laparotomy was performed, and a right iliac artery injury was discovered and successfully repaired by general and vascular surgeons. The patient was discharged home without sequelae after 10 days.

Conclusion.

Lasers are used in many different medical fields and offer unique advantages. However, the physical capabilities of a laser should be fully recognized to avoid complication. In this case, prompt diagnosis and emergent laparotomy salvaged the laser-induced arterial injury.

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