How to treat jatrogenic ureteral injury after posterior spinal surgery? Case report and review of literature

IJU Case Rep, 2023 · DOI: 10.1002/iju5.12612 · Published: July 26, 2023

Simple Explanation

The case report discusses a rare complication of spinal surgery, specifically a ureteral injury, which is an injury to the tube that carries urine from the kidney to the bladder. The patient experienced lumbar pain and fever two weeks after spinal surgery, leading to the discovery of the injury through a CT scan. The report suggests that clinicians should be vigilant for ureteral injuries in patients experiencing these symptoms post-spinal surgery and that surgical intervention may be necessary if initial treatments like ureteral stents are unsuccessful.

Study Duration

6 months

Participants

One 49-year-old female

Evidence Level

Level 4, Case Report

Key Findings

1
Ureteral injury can occur as a rare complication of posterior spinal surgery, even with minimally invasive approaches.
2
Delayed lumbar or abdominal pain associated with high fever and elevated blood creatinine levels after spinal surgery should raise suspicion for ureteral injury.
3
Open surgery with stricture resection and primary anastomosis is preferable after an unsuccessful trial with ureteral stent placement.

Research Summary

This case report describes a 49-year-old female who experienced a ureteral injury after undergoing transforaminal lumbar discectomy and foraminotomy (TLDF). The patient presented with lumbar pain and fever, and the injury was diagnosed via CT scan. Initial treatment with a ureteral stent failed, necessitating surgical ureteroplasty. The report emphasizes the importance of considering ureteral injury in patients with relevant symptoms after spinal surgery and suggests that surgical intervention may be required following unsuccessful stent placement.

Practical Implications

Increased Awareness

Clinicians should maintain a high index of suspicion for ureteral injuries in patients presenting with lumbar pain, fever, and elevated creatinine levels post-spinal surgery.

Diagnostic Protocol

Contrast-enhanced CT and retrograde urography are valuable tools for diagnosing ureteral injuries in a timely manner.

Treatment Strategy

Surgical intervention, including stricture resection and primary anastomosis, should be considered if initial ureteral stent placement fails to resolve the ureteral stricture.

Study Limitations

1
Single case report limits generalizability.
2
Lack of detailed information on the specific surgical technique during the initial spinal procedure.
3
Limited follow-up period of 6 months.

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