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Minimally invasive lateral approaches to the lumbar spine allow for interbody fusion with good visualization of the disk space, minimal blood loss, and decreased length of stay. Major neurologic, vascular, and visceral complications are rare with this approach; however, the steps in management for severe vascular injuries are not well defined. We present a case report of aortic injury during lateral interbody fusion and discuss the use of endovascular repair. This study is a case report of an intraoperative aortic injury. A 59-year-old male with ankylosing spondylitis suffered an acute L1 Chance fracture after mechanical fall. He was taken to the operating room for a T10–L4 posterior instrumented fusion followed by a minimally invasive L1–L2 lateral interbody fusion for anterior column support. During the discectomy, brisk arterial bleeding was encountered due to an aortic injury. The vascular surgery team expanded the incision in an attempt to control the bleeding but with limited success. The patient underwent intraoperative angiogram with placement of stent grafts at the level of the injury followed by completion of the interbody fusion. Despite the potentially catastrophic nature of this injury, the patient made a good recovery and was discharged home in stable condition with no new neurologic deficits. This case highlights the importance of immediate recognition and imaging of any potential vascular injury during minimally invasive lateral interbody fusion. Given the poor outcomes associated with attempted open repair, endovascular techniques provide a valuable tool for the treatment of these complex injuries with significantly less morbidity.

Radionuclide synovectomy is a reliable therapy in patients with chronic synovitis. However, radiation doses delivered to non-target organ systems due to leakage of radioactive material from the articular cavity are an important disadvantage of this procedure. In this study we compared extraarticular leakage values of the 3 commonly used radiopharmaceuticals;90Y-citrate,90Y-silicate and186Re-sulfide colloid. Thirty-five patients with persistent synovitis were enrolled in the study. Twenty-two hemophilic, 8 rheumatoid arthritis and 5 patients with pigmented villonodular synovitis were studied.90Y labeled silicate and citrate were used for knee joints and186Re-sulfide for intermediate sized joints. Radiocolloid leakage values were evaluated using a gamma camera with 20% window centered over the bremsstrahlung photopeak of90Y and a respective window over the 137 keV photopeak of186Re. Regions of interest were drawn over the injection site, the regional lymph nodes and the background areas. Leakage of radiocolloid was calculated by dividing the counts/pixel in the regional lymph node area to the counts/pixel in the injection site. No visible leakage was observed. The median leakage values calculated for90Y-citrate,90Y-silicate and186Re-sulfide were found as 1.9%, 2.4% and 2.7%, respectively. The difference between the variability of leakage values was not statistically significant (p > 0.05).Conclusion: There was no significant difference in terms of extraarticular leakage between90Y-citrate,90Y-silicate and186Re-sulfide radiocolloids.