Despite their benign nature some symptomatic aggressive vertebral haemangiomas (AVH) require surgery to decompress spinal cord and/or stabilise pathological fractures. Preoperative embolisation may reduce the considerable blood loss during surgical decompression. This systematic review investigated whether preoperative embolisation reduced surgical blood loss during treatment of symptomatic AVH. PubMed Medline, Web of Science, and Ovid Medline were searched for case reports and clinical studies on surgical AVH treatment. Included were cases from all publications on surgical treatment of AVH where the amount of surgical blood loss and the use of preoperative embolisation were documented. 51 cases with surgically treated AVH were retrieved from the included studies. Blood loss in the embolised treatment group (980±683 mL) was lower than the non-embolised control group (1,629±946 mL). This systematic review found that embolisation prior to AVH resection reduced surgical blood loss (level of evidence, very low) and can be recommended (strong recommendation).

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Vascular injury in lumbar disk disease is a common complication reviewed in the literature. In our study, we reviewed the rare complication of vascular injury that occurs during lumbar microscopic tubular discectomy. The patient is a 46-year-old male, diabetic, hypertensive and a smoker who presented with a history of backache and right-sided radiculopathy to S1 dermatome for 6 weeks. Conservative measures failed, and we planned and performed microscopic tubular discectomy at the level of L5-S1. Immediately postoperatively, the patient developed acute, sharp, burning pain in the left leg, partially relieved on hip flexion, with diminished distal pulsation of dorsalis pedis, popliteal and femoral. Urgent consultation with a vascular surgeon included a computed tomography angiography which confirmed a vascular injury of the left iliac artery and vein near the bifurcation. The plan involved urgent retroperitoneal exploration of the left iliac vessels, and primary repair with synthetic graft was done with distal embolectomy to regain distal pulsation postoperatively. Further follow-up revealed that the repair was successful.

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