Median sacral artery injury during percutaneous mechanical disc decompression using Dekompressor®.

Abstract

Disc decompression using the Dekompressor® (Stryker, Kalamazoo, MI, USA) is an effective procedure for treating patients with contained disc herniation [1,2,3,4,5]. Iatrogenic vascular injuries during lumbar disc decompression, although rare, are serious complications, that can be fatal without prompt diagnosis and management [5]. In this paper we present the case of a 23-year-old man with median sacral artery injury during lumbar disc decompression using the Dekompressor®. After the procedure, blood pressure decreased, and dizziness, and abdominal pain occurred in the recovery room. Abdomino-pelvic computed tomography (CT) without contrast medium showed a 7.5 cm sized hematoma in the left prevertebral space of the L5-S1 level. Leakage of contrast medium from the median sacral artery was noted by a contrast-enhanced CT scan (Fig. 1). Fortunately, the patient's vital signs were generally maintained by rapid transfusion. The next day, the patient underwent a repeat contrast-enhanced CT scan. There was no definite contrast extravasation, and the size of the retroperitoneal hematoma had decreased from 7.5 to 6 cm. The patient was treated by conservative management and recovered uneventfully. Fig. 1 Contrast-enhanced CT images (A and B) show focal areas of high attenuation (white arrows) from the median sacral artery (black arrows) within the hematoma, a finding that represents an active bleeding.