Ureteral injury after posterior lumbar discectomy with interbody screw fixation

We report a case of iatrogenic ureteral injury secondary to L5 laminectomy and microdiscectomy with L5–S1 bone graft with posterior lumbar interbodyfusion using presacral cancellous screw fixation, managed by initial ureteral stent placement and subsequent Boari bladder flap repair. A 33-year-old woman underwent L5 laminectomy and microdiscectomy with L5–S1 bone graft with posterior lumbar interbody fusion using presacral cancellous screw fixation. On postoperative day 10, she developed lower abdominal pain, vomiting and fever. Ultrasonogram and contrast-enhanced CT demonstrated a large pelvic urinoma secondary to a right lower ureteric injury. This was managed initially by ureteral stent placement and subsequent Boari bladder flap repair. Ureteral injury following spinal surgery is a rare surgical complication with significant morbidity and mortality. A high index of suspicion is essential for early appropriate management and renal salvage.