Direct lesion and repair of a common iliac vein during XLIF approach.

Purpose: Description of a case of direct intraoperative lesion and repair of a major vascular injury of common iliac vein during an extreme lateral interbody fusion L4-L5 procedure.

Methods: A 69-year-old female who was operated for L4-L5 spondilolysthesis suffered a major vascular injury of a vein. The high cava bifurcation and inadequate pre-operative analysis of the radiological documentation resulted in the lesion. The lesion was successfully repaired and the patient did not suffer post-operative sequelae.

Results: The repair was successful although the index spine procedure was not ended. Detailed pre-operative planning, based on radiological examination of vascular structures, should be a mandatory step prior to this specific surgical approach.

Conclusion: Although safer than anterior retroperitoneal approach, extreme lateral interbody fusion still bears risk for major vascular injury.