URING intervertebral disc surgery, vascular injuries rarely occur. It has been reported that the inci- dence of symptomatic vascular complications ranges from 0.016 to 0.17%. 1,11,12 The mortality rate has been reported to range from 15 to 61%. 1,12 The great ves- sels, which are in proximity to the vertebral column, are at risk of injury intraoperatively because of their loca- tion. 1,12,13,18 Early complications are often identified by hy- potension due to severe bleeding. The most common late complications are AVF and pseudoaneurysm. 13 Vascular complications often occur during L4–5 disc surgery. 5 The importance of early diagnosis and emergency sur- gical intervention in cases involving early-onset postoper- ative complication is emphasized in the literature, al- though therapeutic strategies, which should be well assessed in urgent surgery, and the best surgical approach (retroperitoneal or transperitoneal) remain controversial. In this study we reported on 13 patients with vascular complications of lumbar disc surgery performed at our hos- pital or at other hospitals. We discuss the importance of early diagnosis, treatment techniques, and the results of two surgical approaches (retroperitoneal or transperitoneal). Clinical Material and Methods All patients were men with a mean age of 36 years ( 11 years [standard deviation]). All vascular injury compli- cations due to lumbar disc surgery were caused by neuro- surgeons. Lumbar disc surgery was performed via the pos- terior approach in all cases. Early Complications In five of eight cases in which complications developed in the early postoperative period, vascular injuries were documented at our two military centers (three cases in Gülhane Military Medical Academy, Ankara, and two cases at Gülhane Military Medical Academy, Istanbul) (total number of patients 3614) and the other three cases occurred at another hospital (total 2309 patients). In the latter three cases, general surgeons initially controlled the J. Neurosurg: Spine / Volume 100 / March, 2004 J Neurosurg (Spine 3) 100:249–253, 2004 Vascular complications related to lumbar disc surgery HAKAN BINGOL, M.D., F ARUK CINGOZ, M.D., AHMET TURAN YILMAZ, M.D., MEHMET Y ASAR, M.D., AND HARUN T ATAR, M.D. Department of Cardiovascular Surgery and Neurosurgery, and Emergency Department of Surgery, Gulhane Military Medical Academy, Ankara, Turkey Object. Vascular complications related to lumbar disc operations are rare but extremely fatal conditions. The authors analyzed data retrospectively obtained in 13 patients with vascular complications that occurred during lum- bar disc operations performed between January 1990 and January 2002. Methods. One patient underwent an L5–S1 procedure and the remaining underwent L4–5 surgery. Missed injuries, which were found during the late postoperative period, included pseudoaneurysm in four cases and an arte- riovenous fistula in one. In all cases except one in which complication occurred early in the postoperative period, the retroperitoneal area was reached via a transperitoneal approach. In eight patients with complications occurring early in the postoperative period, Dacron graft was placed in four with arterial injuries and saphenous vein graft in one. In three cases of arterial injury and five of venous injury, the lesion was repaired using the primer suture tech- nique. The most commonly affected vessels were left common iliac arteries (76.9%) and left common iliac vein (30.8%). In eight early cases, shock or preshock due to hemorrhage developed during the early phase. During the late postop- erative period, graft-related infection occurred in two cases in which Dacron graft was placed, and axillofemoral extraanatomical bypass surgery was later performed. There was no surgery-related death. During a mean follow-up period of 5.6 years, none of the patients suffered any problems related to vascular injury. Conclusions. Despite its low incidence, iatrogenic vascular injury related to lumbar disc surgery is a possible complication. During lumbar disc operations early diagnosis of vascular injuries and urgent transperitoneal surgery can save patients’ lives. KEY WORDS • vascular surgery • complication • lumbar disc surgery • retroperitoneal approach • hemorrhage • graft D 249 Abbreviation used in this paper: AVF = arteriovenous fistula.