Iatrogenic ureteral injury secondary to a thoracolumbar lateral revision instrumentation and fusion

Background context: Urologic, gynecologic, and colorectal surgical procedures account for most of the iatrogenic ureteral injuries; however, iatrogenic injury secondary to thoracolumbar spinal surgery remains a rare complication. Purpose: To report a case of iatrogenic ureteral injury secondary to a thoracolumbar lateral revision instrumentation and fusion managed by percutaneous nephrostomy, ureteroureterostomy, and ureteral stent placement. Study design: Case report. Methods: A 24-year old female underwent surgical removal of a lumbar plate and broken screw with placement of a unirod spanning L1-L3 through a thoracolumbar exposure with resection of the twelfth rib. Results: On postoperative day 14 she developed left flank pain. Computed tomography scan of the abdomen and pelvis demonstrated a left perinephric fluid collection. After placement of a nephrostomy tube, a retrograde pyelogram with a concomitant antegrade nephrostogram confirmed the diagnosis of ureteral entrapment in the lumbar instrumentation. A spatulated end to end ureteral anastomosis (ureteroureterostomy) was performed over a double J ureteral stent. Conclusions: Although an iatrogenic ureteral injury secondary to thoracolumbar surgery is rare, it should be included in the differential diagnosis for a patient presenting with flank pain after undergoing lateral thoracolumbar fusion. A urinoma, also an uncommon occurrence, may be a presenting sign. Prompt diagnosis and institution of appropriate corrective surgical procedures may result in successful outcome.