Lumbar disc surgery is a very common procedure. Complications are rare, apart from neurological ones, but major vascular injuries are a serious complication. Despite advances in surgical techniques, vascular injuries may still occur. The literature even includes cases identified in the 1950s
5. Similar cases have also been reported recently
6,7,8. The patient's position during surgery, history of similar surgical procedures, presence or absence of pillows placed in the abdominal area, degeneration in the ligament, and annuli fibrosi during the disease process all influence the probability of vascular injury
9,10.
Most cases of vascular injury result from lumbar disc surgery at the L4-L5 and L5-S1 levels 11. The surgical intervention on our patient is similar to that reported in the literature. Since vascular complications are extremely rare during lumbar disc surgery, they are not a main area of concern for surgeons performing the operation. Depending on the type and location of the injury, the bleeding occasionally does not present as active bleeding during the operation and may instead present as abdominal pain, abdominal distension, and lower extremity ischemia in the hours following the operation 12. In young patients, diagnosis may be delayed due to compensatory mechanisms. In our patient, examinations for vascular injury were initiated approximately 5-6 hours after the operation ended. In the late period, vascular injuries may result in complications, such as pseudoaneurysms and arteriovenous fistula formation. The diagnoses for these can be made during the investigation of symptoms, such as thrombosis in cases of localized compression, and swelling in the legs, murmurs, and shortness of breath in cases of fistulas.
In patients referred for emergency operations due to vascular injury, adequate fluid replacement is crucial, especially in patients with hypovolemic shock. These patients can lose about 30% of their total blood volume in a very short period and require a large amount of blood replacement. Studies have investigated the use of autotransfusion systems to reduce the need for blood from blood banks in patients who are expected to bleed excessively 13,14. Since autotransfusion systems do not require extensive preparation, they can be easily used in emergencies 15. These systems consist of a reservoir where the aspirated blood is collected and sections where the blood is heparinized, washed, and reinfused. In our patient, we aspirated and filtered a total of 1600 mL of blood from the surgical site using an autotransfusion system and then transfused it back into the patient. We believe that this was effective in ensuring the patient’s rapid discharge from the hospital (on the 6th postoperative day) with full recovery.