Injury of the ureter is a potentially devastating complication most often reported in gynecologic, colorectal, and vascular pelvic operations or endoscopic procedures for ureteric pathologies. Our objectives are to present a literature review and meta-analysis of ureteral injury during posterior spine operation, and to describe a rare case of ureteral rupture occurring as a complication of percutaneous pedicle screw placement.

PubMed and EMBASE were screened for studies of ureteral injury caused by posterior lumbar operation. Studies in any other language than English were excluded. A case illustration is presented. Clinical Presentation: A 60-year-old man complained of unbearable abdominal pain on the day after right L4-L5 transforaminal intervertebral fusion and percutaneous pedicle screw placement. The computer tomography scan revealed contrast media extravasation outside the excretory system consistent with a left ureteral traumatic perforation. He underwent left nephrostomy and double-J stent insertion, and subsequently fully recovered. The ureter completely healed, enabling stent removal 5 months later.

Of 118 references, we found 27 reports of ureteral injury caused by posterior lumbar operation, with only one other case following minimally invasive transforaminal lumbar interbody fusion (MI-TLIF). Complications of minimally invasive pedicle screw placement are often described as a dural tear or neurologic impairment. A meta-analysis of the literature found 27 patients with ureteral injury as a complication of spine operation. Our reported case is the first described after MI-TLIF.

This report shows that unexpected side effects of MI-TLIF are still possible, and spine surgeons should be aware of this, especially while performing minimally invasive procedures, in which by definition, the pedicles are concealed for direct visualization.