Arterial injury following percutaneous vertebral augmentation - A case report

Study Design. Case report. Objective. To report a case of injury to a segmental branch of the L4 lumbar artery following kyphoplasty. Summary of Background Data. To our knowledge, arterial injury following vertebral augmentation has not been described. The complications that have been reported rarely require additional intervention. The caliber of the fourth lumbar artery is such that injury to it, or to its more proximal branches, may cause significant morbidity. Methods. An 84-year-old female who presents 10 days after surgery from L5 kyphoplasty with pulsatile bleeding from the kyphoplasty site. An angiogram revealed an injury to a segmental branch of L4 lumbar artery. Results. A superselective angiogram was performed, followed by embolization of a branch of the L4 lumbar artery. This procedure successfully controlled the bleeding. Conclusion. Surgeons performing percutaneous procedures for the augmentation of vertebral compression fractures are not able to visualize the arterial channels on the posterior aspect of the vertebral column. Although injury to these structures may be difficult to prevent, awareness of this complication will improve our response and decrease associated morbidity.