array:23 [
  "pii" => "S1130147304704844"
  "issn" => "11301473"
  "doi" => "10.1016/S1130-1473(04)70484-4"
  "estado" => "S300"
  "fechaPublicacion" => "2004-01-01"
  "aid" => "70484"
  "copyright" => "Sociedad Española de Neurocirugía"
  "copyrightAnyo" => "2004"
  "documento" => "article"
  "crossmark" => 0
  "subdocumento" => "fla"
  "cita" => "Neurocirugia. 2004;15:279-84"
  "abierto" => array:3 [
    "ES" => false
    "ES2" => false
    "LATM" => false
  ]
  "gratuito" => false
  "lecturas" => array:2 [
    "total" => 2804
    "formatos" => array:3 [
      "EPUB" => 18
      "HTML" => 1432
      "PDF" => 1354
    ]
  ]
  "itemSiguiente" => array:18 [
    "pii" => "S1130147304704856"
    "issn" => "11301473"
    "doi" => "10.1016/S1130-1473(04)70485-6"
    "estado" => "S300"
    "fechaPublicacion" => "2004-01-01"
    "aid" => "70485"
    "copyright" => "Sociedad Española de Neurocirugía"
    "documento" => "article"
    "crossmark" => 0
    "subdocumento" => "fla"
    "cita" => "Neurocirugia. 2004;15:285-9"
    "abierto" => array:3 [
      "ES" => false
      "ES2" => false
      "LATM" => false
    ]
    "gratuito" => false
    "lecturas" => array:2 [
      "total" => 2378
      "formatos" => array:3 [
        "EPUB" => 16
        "HTML" => 891
        "PDF" => 1471
      ]
    ]
    "es" => array:10 [
      "idiomaDefecto" => true
      "titulo" => "Meduloblastoma de presentación extra-axial en el ángulo pontocerebeloso"
      "tienePdf" => "es"
      "tieneTextoCompleto" => 0
      "tieneResumen" => array:2 [
        0 => "es"
        1 => "en"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "285"
          "paginaFinal" => "289"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "en" => array:1 [
          "titulo" => "Medulloblastoma presenting as an extra-axial tumor in the cerebellopontine angle"
        ]
      ]
      "contieneResumen" => array:2 [
        "es" => true
        "en" => true
      ]
      "contienePdf" => array:1 [
        "es" => true
      ]
      "autores" => array:2 [
        0 => array:2 [
          "autoresLista" => "J.L. Gil-Salú, F. Rodríguez-Peña, M. López-Escobar"
          "autores" => array:3 [
            0 => array:2 [
              "nombre" => "J.L."
              "apellidos" => "Gil-Salú"
            ]
            1 => array:2 [
              "nombre" => "F."
              "apellidos" => "Rodríguez-Peña"
            ]
            2 => array:2 [
              "nombre" => "M."
              "apellidos" => "López-Escobar"
            ]
          ]
        ]
        1 => array:2 [
          "autoresLista" => "M.J. Palomo"
          "autores" => array:1 [
            0 => array:2 [
              "nombre" => "M.J."
              "apellidos" => "Palomo"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "es"
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1130147304704856?idApp=UINPBA00004B"
    "url" => "/11301473/0000001500000003/v1_201305151221/S1130147304704856/v1_201305151221/es/main.assets"
  ]
  "itemAnterior" => array:18 [
    "pii" => "S1130147304704832"
    "issn" => "11301473"
    "doi" => "10.1016/S1130-1473(04)70483-2"
    "estado" => "S300"
    "fechaPublicacion" => "2004-01-01"
    "aid" => "70483"
    "copyright" => "Sociedad Española de Neurocirugía"
    "documento" => "article"
    "crossmark" => 0
    "subdocumento" => "fla"
    "cita" => "Neurocirugia. 2004;15:270-8"
    "abierto" => array:3 [
      "ES" => false
      "ES2" => false
      "LATM" => false
    ]
    "gratuito" => false
    "lecturas" => array:2 [
      "total" => 2258
      "formatos" => array:3 [
        "EPUB" => 14
        "HTML" => 1002
        "PDF" => 1242
      ]
    ]
    "es" => array:10 [
      "idiomaDefecto" => true
      "titulo" => "Estudio comparativo de la artrodesis cervical con injerto óseo roscado e implante de titanio"
      "tienePdf" => "es"
      "tieneTextoCompleto" => 0
      "tieneResumen" => array:2 [
        0 => "es"
        1 => "en"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "270"
          "paginaFinal" => "278"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "en" => array:1 [
          "titulo" => "Anterior cervical interbody fusion with treathed cylindrical bone versus bak-cace: a comparative study"
        ]
      ]
      "contieneResumen" => array:2 [
        "es" => true
        "en" => true
      ]
      "contienePdf" => array:1 [
        "es" => true
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "L.F. Porras-Estrada, L.F. Ugarriza-Echebarrieta, L. Lorenzana-Honrado, J.A. Rodríguez-Sánchez, L.M. García-Yagüe, I. Fernández-Portales, L. Gómez-Perals, J.M. Cabezudo"
          "autores" => array:8 [
            0 => array:2 [
              "nombre" => "L.F."
              "apellidos" => "Porras-Estrada"
            ]
            1 => array:2 [
              "nombre" => "L.F."
              "apellidos" => "Ugarriza-Echebarrieta"
            ]
            2 => array:2 [
              "nombre" => "L."
              "apellidos" => "Lorenzana-Honrado"
            ]
            3 => array:2 [
              "nombre" => "J.A."
              "apellidos" => "Rodríguez-Sánchez"
            ]
            4 => array:2 [
              "nombre" => "L.M."
              "apellidos" => "García-Yagüe"
            ]
            5 => array:2 [
              "nombre" => "I."
              "apellidos" => "Fernández-Portales"
            ]
            6 => array:2 [
              "nombre" => "L."
              "apellidos" => "Gómez-Perals"
            ]
            7 => array:2 [
              "nombre" => "J.M."
              "apellidos" => "Cabezudo"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "es"
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1130147304704832?idApp=UINPBA00004B"
    "url" => "/11301473/0000001500000003/v1_201305151221/S1130147304704832/v1_201305151221/es/main.assets"
  ]
  "es" => array:14 [
    "idiomaDefecto" => true
    "titulo" => "Complicaciones intra-abdominales de la cirugía de la hernia discal lumbar"
    "tieneTextoCompleto" => 0
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "279"
        "paginaFinal" => "284"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "G. Bilbao, I. Menchacatorre, M. Uriguen, I. Pomposo, F. Bardón, I. Urquidi, J. Garibi"
        "autores" => array:7 [
          0 => array:4 [
            "nombre" => "G."
            "apellidos" => "Bilbao"
            "email" => array:1 [
              0 => "gbilbao@hcru.osakidetza.net"
            ]
            "referencia" => array:2 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">&#42;</span>"
                "identificador" => "aff0005"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">¿</span>"
                "identificador" => "cor0005"
              ]
            ]
          ]
          1 => array:3 [
            "nombre" => "I&#46;"
            "apellidos" => "Menchacatorre"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">&#42;</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
          2 => array:3 [
            "nombre" => "M&#46;"
            "apellidos" => "Uriguen"
            "referencia" => array:2 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">1</span>"
                "identificador" => "aff0020"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">&#42;</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
          3 => array:3 [
            "nombre" => "I&#46;"
            "apellidos" => "Pomposo"
            "referencia" => array:2 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">1</span>"
                "identificador" => "aff0020"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">&#42;</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
          4 => array:3 [
            "nombre" => "F&#46;"
            "apellidos" => "Bard&#243;n"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">&#42;&#42;</span>"
                "identificador" => "aff0010"
              ]
            ]
          ]
          5 => array:3 [
            "nombre" => "I&#46;"
            "apellidos" => "Urquidi"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">&#42;&#42;&#42;</span>"
                "identificador" => "aff0015"
              ]
            ]
          ]
          6 => array:3 [
            "nombre" => "J&#46;"
            "apellidos" => "Garibi"
            "referencia" => array:2 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">1</span>"
                "identificador" => "aff0020"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">&#42;</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:4 [
          0 => array:3 [
            "entidad" => "Servicios de Neurocirug&#237;a&#46; Hospital de Cruces"
            "etiqueta" => "<span class="elsevierStyleSup">&#42;</span>"
            "identificador" => "aff0005"
          ]
          1 => array:3 [
            "entidad" => "Cirug&#237;a Vascular&#46; Hospital de Cruces"
            "etiqueta" => "<span class="elsevierStyleSup">&#42;&#42;</span>"
            "identificador" => "aff0010"
          ]
          2 => array:3 [
            "entidad" => "Cirug&#237;a General&#46; Hospital de Cruces"
            "etiqueta" => "<span class="elsevierStyleSup">&#42;&#42;&#42;</span>"
            "identificador" => "aff0015"
          ]
          3 => array:3 [
            "entidad" => "Departamento de Cirug&#237;a&#46; Universidad del Pa&#237;s Vasco&#46; Bilbao"
            "etiqueta" => "<span class="elsevierStyleSup">1</span>"
            "identificador" => "aff0020"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0005"
            "etiqueta" => "&#8270;"
            "correspondencia" => "Correspondencia postal&#58; Servicio de Neurocirug&#237;a&#46; Hospital de Cruces&#46; Plaza de Cruces&#46; 48903 Baracaldo&#46; Bizkaia&#46;"
          ]
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2003-05-05"
    "fechaAceptado" => "2003-12-09"
    "PalabrasClave" => array:2 [
      "es" => array:2 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec158459"
          "palabras" => array:5 [
            0 => "Hernia lumbar"
            1 => "Cirug&#237;a"
            2 => "Perforaci&#243;n"
            3 => "Intestino"
            4 => "Vascular"
          ]
        ]
        1 => array:4 [
          "clase" => "abr"
          "titulo" => "Abreviaturas"
          "identificador" => "xpalclavsec158460"
          "palabras" => array:1 [
            0 => "URPA"
          ]
        ]
      ]
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Key words"
          "identificador" => "xpalclavsec158458"
          "palabras" => array:5 [
            0 => "Lumbar dise herniation"
            1 => "Surgery"
            2 => "Perforation"
            3 => "Intestine"
            4 => "Vascular"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "es" => array:2 [
        "titulo" => "Resumen"
        "resumen" => "<span class="elsevierStyleSectionTitle">Introducci&#243;n</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">La extirpaci&#243;n de la hernia discal lumbar es actualmente el acto quir&#250;rgico m&#225;s habitual sobre el raquis en los servicios de Neurocirug&#237;a&#44; con un n&#250;mero de complicaciones muy escasas y unas estancias hospitalarias realmente cortas&#46; Sin embargo&#44; y a pesar de la rareza&#44; es posible la aparici&#243;n de complicaciones intraoperatorias muy graves que son necesarias conocer puesto que un diagn&#243;stico y tratamiento precoces pueden evitar el fallecimiento del paciente&#46; Es importante involucrar a &#233;ste en el conocimiento de estas posibles complicaciones y obtener un consentimiento informado por escrito para evitar problemas m&#233;dicolegales posteriores&#46;</p> <span class="elsevierStyleSectionTitle">Casos cl&#237;nicos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Presentamos dos casos de lumboci&#225;tica t&#237;pica secundaria a hernia discal lumbar intervenidos en el Servicio de Neurocirug&#237;a de Cruces que se complicaron con la perforaci&#243;n intraoperatoria de estructuras intraabdominales&#46; En ambos casos se realiz&#243; una flavectom&#237;a y extirpaci&#243;n discal simple de forma habitual&#46; La sintomatolog&#237;a comenz&#243; algunas horas despu&#233;s de la cirug&#237;a con dolor abdominal e hipotensi&#243;n en uno y otro caso&#46; El diagn&#243;stico precoz se realiz&#243; mediante TAC abdomino-p&#233;lvico&#46; Posteriormente&#44; y de forma urgente los Servicios de Cirug&#237;a General y Cirug&#237;a Vascular realizaron sendas laparotom&#237;as&#44; posibilitando la reparaci&#243;n de una perforaci&#243;n intestinal en un paciente y de un desgarro de la arteria y vena iliacas en el otro&#44; evitando as&#237; fatales consecuencias&#46; Actualmente ambos est&#225;n asintom&#225;ticos&#46;</p> <span class="elsevierStyleSectionTitle">Conclusi&#243;n</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">La cirug&#237;a de la hernia discal lumbar&#44; en la gran mayor&#237;a de los casos muy agradecida en cuanto a la desaparici&#243;n del dolor&#44; no est&#225; exenta de complicaciones tan raras como graves&#46; La perforaci&#243;n intestinal y el desgarro vascular son dos ejemplos que hay que conocer y sospechar ante la aparici&#243;n de dolor abdominal o hipotensi&#243;n arterial sist&#233;mica en el postoperatorio&#44; a pesar de que la extirpaci&#243;n discal discurra sin incidencias&#46; El diagn&#243;stico precoz mediante TAC abdomino-p&#233;lvico dirigir&#225; la actitud hacia un tratamiento quir&#250;rgico urgente de dichas lesiones&#46; Es de m&#225;xima importancia que el paciente conozca la existencia de las posibles complicaciones de la cirug&#237;a de la hernia discal y obtener su consentimiento por escrito&#46;</p>"
      ]
      "en" => array:2 [
        "titulo" => "Summary"
        "resumen" => "<span class="elsevierStyleSectionTitle">Introduction</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Removal of a lumbar disc herniation is&#44; at present&#44; the most frequent surgical procedure&#44; related to the spine in Neurosurgical Departments&#46; It carries a very low rates of complications and a short postoperative hospital stay&#46; However&#44; in spite of their rarity&#44; serious adverse intraoperative complications may occur&#44; so we must be aware of its existence in order to make an early diagnosis and treatment to prevent a fatal outcome&#46; It is important to ensure that the patient understand the possible complications and obtaining written consent to avoid later medico-legal problems&#46;</p> <span class="elsevierStyleSectionTitle">Clinical cases</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">We report two cases with typical lumbo-ciatic pain secondary to lumbar disc herniation operated at our Department&#44; that resulted in intraoperative complications&#44; due to perforation of intraabdominal structu-res&#46; Initially&#44; the patients underwent planned flavectomy&#44; followed by simple disc removal&#46; However&#44; symptoms of abdominal pain and systemic hypotension in each case&#44; began some hours later&#46; Early diagnosis was achieved using abdominal-pelvic CT sean&#44; showing an intestinal perforation in one patient and a tear of both iliac artery and vein in the other&#46; In both&#44; an urgent laparotomy was performed by colleagues from the Department of General and Vascular Surgery&#44; with surgical repair&#46; The final outcome was good and both are asymptomatic&#46;</p> <span class="elsevierStyleSectionTitle">Conclusion</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Surgical removal of the lumbar disc herniation is a very effective procedure&#44; but is not free from certain severe though rare complications&#46; Intestinal perforation and vascular tears are two possible complications to suspect if abdominal pain or systemic arterial hypotension appear in the postoperative period&#44; even though disc removal was uneventful&#46; Early diagnosis made by abdomino-pelvic CT sean makes possible subse-quent urgent surgical repair of such complications&#46; It is of vital importante that the patient knows the existente of such complications and so obtain a written consent&#46;</p>"
      ]
    ]
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara">Bilbao&#44; G&#46;&#59; Menchacatorre&#44; L&#59; Uriguen&#44; M&#46;&#59; Pomposo&#44; L&#59; Bard&#243;n&#44; F&#46;&#59; Urquidi&#44; L&#59; Garibi&#44; F&#46;&#58; Complicaciones intra-abdominales de la cirug&#237;a de la hernia discal lumbar&#46; Neurocirug&#237;a 2004&#59; 15&#58; 279&#8211;284&#46;</p>"
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "Bibliograf&#237;a"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:30 [
            0 => array:3 [
              "identificador" => "bib1"
              "etiqueta" => "1&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Ureteral injury associated with lumbar disc surgery"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "V&#46;K&#46; Altebannakian"
                            1 => "R&#46;S&#46; Davis"
                            2 => "F&#46;J&#46; Khuri"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Urology"
                        "fecha" => "1981"
                        "volumen" => "17"
                        "paginaInicial" => "462"
                        "paginaFinal" => "464"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7233661"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib2"
              "etiqueta" => "2&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Anterior perforations in lumbar discectomies&#46; A report of four cases of vascular complications and a CT study of the prevertebral lumbar anatomy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "S&#46; Anda"
                            1 => "S&#46; Aakhus"
                            2 => "K&#46;O&#46; Skaanes"
                            3 => "E&#46; Sande"
                            4 => "H&#46; Schrader"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Spine"
                        "fecha" => "1991"
                        "volumen" => "16"
                        "paginaInicial" => "54"
                        "paginaFinal" => "60"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2003238"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib3"
              "etiqueta" => "3&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Major vascular injuries in lumbar disc surgery"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "I&#46;W&#46; Birkeland"
                            1 => "T&#46;K&#46; Taylor"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Bone Joint Surg Br"
                        "fecha" => "1969"
                        "volumen" => "51"
                        "paginaInicial" => "4"
                        "paginaFinal" => "19"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/5766360"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib4"
              "etiqueta" => "4&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Bowel injuries coincident to lumbar disk surgery&#58; a report of four cases and a review of the literatee"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "I&#46;W&#46; Birkeland"
                            1 => "T&#46;K&#46; Taylor"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Trauma"
                        "fecha" => "1970"
                        "volumen" => "10"
                        "paginaInicial" => "163"
                        "paginaFinal" => "168"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/5417543"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib5"
              "etiqueta" => "5&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Arteriovenous fistula and isolated vascular injuries secondary to intervertebral disk surgery&#46; Report of four cases and review of the literatee"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "D&#46;P&#46; Boyd"
                            1 => "G&#46;J&#46; Farha"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Surg"
                        "fecha" => "1965"
                        "volumen" => "161"
                        "paginaInicial" => "524"
                        "paginaFinal" => "531"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14274855"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib6"
              "etiqueta" => "6&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Anterior herniation of a ruptured lumbar intervertebral disk"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "R&#46;B&#46; Cloward"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Arch Surg"
                        "fecha" => "1952"
                        "volumen" => "64"
                        "paginaInicial" => "457"
                        "paginaFinal" => "463"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib7"
              "etiqueta" => "7&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Vascular injury coincident to disc surgery"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "R&#46;L&#46; DeSausare"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "JNeurosurg"
                        "fecha" => "1959"
                        "volumen" => "16"
                        "paginaInicial" => "222"
                        "paginaFinal" => "229"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib8"
              "etiqueta" => "8&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Vascular complications of lumbar dise surgery"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "J&#46; Fruhwirth"
                            1 => "G&#46; Koch"
                            2 => "W&#46; Amann"
                            3 => "H&#46; Hauser"
                            4 => "G&#46; Flaschka"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Acta Neurochir &#40;Wien&#41;"
                        "fecha" => "1996"
                        "volumen" => "138"
                        "paginaInicial" => "912"
                        "paginaFinal" => "916"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib9"
              "etiqueta" => "9&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Vascular and visceral injuries associated with lumbar disc surgery&#58; medicolegal implications"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "R&#46; Goodkin"
                            1 => "L&#46; Lewis"
                            2 => "J&#46;D&#46; Laska"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Surg Neurol"
                        "fecha" => "1998"
                        "volumen" => "49"
                        "paginaInicial" => "358"
                        "paginaFinal" => "372"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9537654"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib10"
              "etiqueta" => "10&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Costbenefit value of microscopic examination of intervertebral discs"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "D&#46;M&#46; Grzybicki"
                            1 => "E&#46;J&#46; Callaghan"
                            2 => "S&#46;S&#46; Raab"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.3171/jns.1998.89.3.0378"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Neurosurg"
                        "fecha" => "1998"
                        "volumen" => "89"
                        "paginaInicial" => "378"
                        "paginaFinal" => "381"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9724110"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib11"
              "etiqueta" => "11&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Major vascular complications of intervertebral disc surgery"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "S&#46;R&#46; Harbison"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Surg"
                        "fecha" => "1954"
                        "volumen" => "140"
                        "paginaInicial" => "342"
                        "paginaFinal" => "348"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/13198071"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib12"
              "etiqueta" => "12&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Percutaneous endovascular stent-graft for iliac pseudoaneurysm following lumbar discectomy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "S&#46;J&#46; Hong"
                            1 => "J&#46;H&#46; Oh"
                            2 => "Y&#46; Yoon"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Cardiovasc Intervent Radiol"
                        "fecha" => "2000"
                        "volumen" => "23"
                        "paginaInicial" => "475"
                        "paginaFinal" => "477"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11232898"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib13"
              "etiqueta" => "13&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Disc pathology"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "N&#46;H&#46; Horwitz"
                            1 => "H&#46; Rizzoli"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "J Neurosurg"
                        "fecha" => "1999"
                        "volumen" => "90"
                        "paginaInicial" => "804"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10193633"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib14"
              "etiqueta" => "14&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Retroperitoneal bleeding after L4-L5 discectomy in a patient with crossed-fused renal ectopia&#58; treatment by selective embolization"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "H&#46; Khan"
                            1 => "D&#46; Didier"
                            2 => "P&#46; Otten"
                            3 => "P&#46; Fransen"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Cardiovasc Intervent Radiol"
                        "fecha" => "1996"
                        "volumen" => "19"
                        "paginaInicial" => "348"
                        "paginaFinal" => "351"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8781158"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib15"
              "etiqueta" => "15&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Emergency diagnosis with spiral CT angiography in case of suspected ventral perforation following lumbar disc sugery"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "M&#46; Lange"
                            1 => "U&#46; Fink"
                            2 => "A&#46; Philipp"
                            3 => "R&#46; Oeckler"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Surg Neurol"
                        "fecha" => "2002"
                        "volumen" => "57"
                        "paginaInicial" => "15"
                        "paginaFinal" => "19"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11834263"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib16"
              "etiqueta" => "16&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Correlative mesurement of anterior margin of anulus for surgical planning"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "T&#46;S&#46; Lewis"
                            1 => "C&#46;F&#46; Lanzieri"
                            2 => "R&#46;W&#46; Hardy"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Spine"
                        "fecha" => "1996"
                        "volumen" => "21"
                        "paginaInicial" => "1537"
                        "paginaFinal" => "1539"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8817781"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            16 => array:3 [
              "identificador" => "bib17"
              "etiqueta" => "17&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Accidents vasculaires au cours de la chirurgie de la hernie discale lombaire&#46; Apropos de 3 cas personnels et de 37 cas colliges dans une enqu&#233;te nationale"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "P&#46; Mercier"
                            1 => "M&#46;C&#46; Donnez"
                            2 => "X&#46; Pap&#243;n"
                            3 => "J&#46;C&#46; Pillet"
                            4 => "A&#46; Pasco-Pap&#243;n"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Neurochirurgie"
                        "fecha" => "1996"
                        "volumen" => "42"
                        "paginaInicial" => "202"
                        "paginaFinal" => "208"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9084747"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib18"
              "etiqueta" => "18&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Results and complicated course after surgery for lumbar disc herniation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "F&#46; Oppel"
                            1 => "A&#46;J&#46; Schramm"
                            2 => "M&#46; Schirmer"
                            3 => "M&#46; Zeitner"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Adv Neurosurg"
                        "fecha" => "1977"
                        "volumen" => "4"
                        "paginaInicial" => "36"
                        "paginaFinal" => "51"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            18 => array:3 [
              "identificador" => "bib19"
              "etiqueta" => "19&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Complications and demographic characteristics of patients undergoing lumbar discectomy in community hospitals"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "L&#46;F&#46; Ram&#237;rez"
                            1 => "R&#46; Thisted"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Neurosurgery"
                        "fecha" => "1989"
                        "volumen" => "25"
                        "paginaInicial" => "226"
                        "paginaFinal" => "231"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2770987"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            19 => array:3 [
              "identificador" => "bib20"
              "etiqueta" => "20&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Bowel perforation following microsurgical lumbar discectomy&#46; A case report"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "A&#46;M&#46; Schwartz"
                            1 => "J&#46;S&#46; Brodkey"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Spine"
                        "fecha" => "1989"
                        "volumen" => "14"
                        "paginaInicial" => "104"
                        "paginaFinal" => "106"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2913652"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            20 => array:3 [
              "identificador" => "bib21"
              "etiqueta" => "21&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:1 [
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "E&#46;B&#46; Smith"
                            1 => "J&#46;R&#46; DeBord"
                            2 => "W&#46;C&#46; Hanigan"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "LibroEditado" => array:4 [
                        "titulo" => "Neurosurgical topics&#58; complications of spinal surgery"
                        "paginaInicial" => "41"
                        "paginaFinal" => "49"
                        "serieFecha" => "1991"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            21 => array:3 [
              "identificador" => "bib22"
              "etiqueta" => "22&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Intestinal injury after lumbar discectomy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "E&#46;B&#46; Smith"
                            1 => "J&#46;R&#46; DeBord"
                            2 => "W&#46;C&#46; Hanigan"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Surgery&#44; Gynecol Obstet"
                        "fecha" => "1991"
                        "volumen" => "173"
                        "paginaInicial" => "22"
                        "paginaFinal" => "24"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            22 => array:3 [
              "identificador" => "bib23"
              "etiqueta" => "23&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Arteriovenous fistula as a complication of operation for prolapsed disc"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "K&#46;A&#46; Solonen"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Ann Chir Gynaecol Fenniae"
                        "fecha" => "1975"
                        "volumen" => "61"
                        "paginaInicial" => "385"
                        "paginaFinal" => "387"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            23 => array:3 [
              "identificador" => "bib24"
              "etiqueta" => "24&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Arteriovenous fistula simulating deep vein thrombosis as a complication of lumbar disc surgery"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "A&#46; Teh"
                            1 => "R&#46; Jeyamalar"
                            2 => "Z&#46;A&#46; Habib"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Med J Malasya"
                        "fecha" => "1993"
                        "volumen" => "48"
                        "paginaInicial" => "440"
                        "paginaFinal" => "442"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            24 => array:3 [
              "identificador" => "bib25"
              "etiqueta" => "25&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Superior rectal artery injury following lumbar disc surgery&#46; Case report"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "Y&#46;D&#46; Tsai"
                            1 => "P&#46;C&#46; Yu"
                            2 => "T&#46;C&#46; Lee"
                            3 => "H&#46;S&#46; Chen"
                            4 => "S&#46;H&#46; Wang"
                            5 => "Y&#46;L&#46; Kuo"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:4 [
                        "tituloSerie" => "J Neurosurgery &#40;Spine 1&#41;"
                        "fecha" => "2001"
                        "volumen" => "95"
                        "paginaInicial" => "108110"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            25 => array:3 [
              "identificador" => "bib26"
              "etiqueta" => "26&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Does microscopic removal of lumbar dise herniation lead to better results than the standard procedure&#63;&#46; Results of a one-year randomized study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "T&#46; Tulberg"
                            1 => "J&#46; Isacson"
                            2 => "L&#46; Weidenhielm"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.3171/2012.9.SPINE12392"
                      "Revista" => array:7 [
                        "tituloSerie" => "Spine"
                        "fecha" => "1993"
                        "volumen" => "18"
                        "paginaInicial" => "24"
                        "paginaFinal" => "27"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23140127"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S0002937810000943"
                          "estado" => "S300"
                          "issn" => "00029378"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            26 => array:3 [
              "identificador" => "bib27"
              "etiqueta" => "27&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Intraoperative komplikationen wahrend lumbarer bandscheibenoperationen"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "U&#46; Wildforster"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1055/s-2008-1052055"
                      "Revista" => array:6 [
                        "tituloSerie" => "Neurochirurgia"
                        "fecha" => "1991"
                        "volumen" => "34"
                        "paginaInicial" => "53"
                        "paginaFinal" => "56"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2052123"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            27 => array:3 [
              "identificador" => "bib28"
              "etiqueta" => "28&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Microsurgical and stan dard removal of the protruded lumbar disc&#58; a comparative study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "D&#46;H&#46; Wilson"
                            1 => "R&#46; Harbaugh"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Neurosurgery"
                        "fecha" => "1981"
                        "volumen" => "8"
                        "paginaInicial" => "422"
                        "paginaFinal" => "427"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7242893"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            28 => array:3 [
              "identificador" => "bib29"
              "etiqueta" => "29&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Posterolateral endoscopio excision for lumbar dise herniation&#58; surgical technique&#44; outcome and complications in 307 consecutive cases"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "A&#46;T&#46; Yeung"
                            1 => "P&#46;M&#46; Tsou"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Spine"
                        "fecha" => "2002"
                        "volumen" => "27"
                        "paginaInicial" => "722"
                        "paginaFinal" => "731"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11923665"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            29 => array:3 [
              "identificador" => "bib30"
              "etiqueta" => "30&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Long-term outcomes of standard discectomy for lumbar disc herniation&#46; A foliow-up study of more than 10 years"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "E&#46; Yorimitsu"
                            1 => "K&#46; Chiba"
                            2 => "Y&#46; Toyama"
                            3 => "K&#46; Hirabayashi"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Spine"
                        "fecha" => "2001"
                        "volumen" => "26"
                        "paginaInicial" => "652"
                        "paginaFinal" => "657"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11246379"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "es"
  "url" => "/11301473/0000001500000003/v1_201305151221/S1130147304704844/v1_201305151221/es/main.assets"
  "Apartado" => null
  "PDF" => "https://static.elsevier.es/multimedia/11301473/0000001500000003/v1_201305151221/S1130147304704844/v1_201305151221/es/main.pdf?idApp=UINPBA00004B&text.app=https://revistaneurocirugia.com/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1130147304704844?idApp=UINPBA00004B"
]
Compartir
Información de la revista
Vol. 15. Núm. 3.
Páginas 279-284 (enero 2004)
Compartir
Compartir
Descargar PDF
Más opciones de artículo
Vol. 15. Núm. 3.
Páginas 279-284 (enero 2004)
Complicaciones intra-abdominales de la cirugía de la hernia discal lumbar
Visitas
2843
G. Bilbao
,
Autor para correspondencia
gbilbao@hcru.osakidetza.net

Correspondencia postal: Servicio de Neurocirugía. Hospital de Cruces. Plaza de Cruces. 48903 Baracaldo. Bizkaia.
, I. Menchacatorre*, M. Uriguen1,*, I. Pomposo1,*, F. Bardón**, I. Urquidi***, J. Garibi1,*
* Servicios de Neurocirugía. Hospital de Cruces
** Cirugía Vascular. Hospital de Cruces
*** Cirugía General. Hospital de Cruces
1 Departamento de Cirugía. Universidad del País Vasco. Bilbao
Este artículo ha recibido
Información del artículo
Resumen
Introducción

La extirpación de la hernia discal lumbar es actualmente el acto quirúrgico más habitual sobre el raquis en los servicios de Neurocirugía, con un número de complicaciones muy escasas y unas estancias hospitalarias realmente cortas. Sin embargo, y a pesar de la rareza, es posible la aparición de complicaciones intraoperatorias muy graves que son necesarias conocer puesto que un diagnóstico y tratamiento precoces pueden evitar el fallecimiento del paciente. Es importante involucrar a éste en el conocimiento de estas posibles complicaciones y obtener un consentimiento informado por escrito para evitar problemas médicolegales posteriores.

Casos clínicos

Presentamos dos casos de lumbociática típica secundaria a hernia discal lumbar intervenidos en el Servicio de Neurocirugía de Cruces que se complicaron con la perforación intraoperatoria de estructuras intraabdominales. En ambos casos se realizó una flavectomía y extirpación discal simple de forma habitual. La sintomatología comenzó algunas horas después de la cirugía con dolor abdominal e hipotensión en uno y otro caso. El diagnóstico precoz se realizó mediante TAC abdomino-pélvico. Posteriormente, y de forma urgente los Servicios de Cirugía General y Cirugía Vascular realizaron sendas laparotomías, posibilitando la reparación de una perforación intestinal en un paciente y de un desgarro de la arteria y vena iliacas en el otro, evitando así fatales consecuencias. Actualmente ambos están asintomáticos.

Conclusión

La cirugía de la hernia discal lumbar, en la gran mayoría de los casos muy agradecida en cuanto a la desaparición del dolor, no está exenta de complicaciones tan raras como graves. La perforación intestinal y el desgarro vascular son dos ejemplos que hay que conocer y sospechar ante la aparición de dolor abdominal o hipotensión arterial sistémica en el postoperatorio, a pesar de que la extirpación discal discurra sin incidencias. El diagnóstico precoz mediante TAC abdomino-pélvico dirigirá la actitud hacia un tratamiento quirúrgico urgente de dichas lesiones. Es de máxima importancia que el paciente conozca la existencia de las posibles complicaciones de la cirugía de la hernia discal y obtener su consentimiento por escrito.

Palabras clave:
Hernia lumbar
Cirugía
Perforación
Intestino
Vascular
Abreviaturas:
URPA
Summary
Introduction

Removal of a lumbar disc herniation is, at present, the most frequent surgical procedure, related to the spine in Neurosurgical Departments. It carries a very low rates of complications and a short postoperative hospital stay. However, in spite of their rarity, serious adverse intraoperative complications may occur, so we must be aware of its existence in order to make an early diagnosis and treatment to prevent a fatal outcome. It is important to ensure that the patient understand the possible complications and obtaining written consent to avoid later medico-legal problems.

Clinical cases

We report two cases with typical lumbo-ciatic pain secondary to lumbar disc herniation operated at our Department, that resulted in intraoperative complications, due to perforation of intraabdominal structu-res. Initially, the patients underwent planned flavectomy, followed by simple disc removal. However, symptoms of abdominal pain and systemic hypotension in each case, began some hours later. Early diagnosis was achieved using abdominal-pelvic CT sean, showing an intestinal perforation in one patient and a tear of both iliac artery and vein in the other. In both, an urgent laparotomy was performed by colleagues from the Department of General and Vascular Surgery, with surgical repair. The final outcome was good and both are asymptomatic.

Conclusion

Surgical removal of the lumbar disc herniation is a very effective procedure, but is not free from certain severe though rare complications. Intestinal perforation and vascular tears are two possible complications to suspect if abdominal pain or systemic arterial hypotension appear in the postoperative period, even though disc removal was uneventful. Early diagnosis made by abdomino-pelvic CT sean makes possible subse-quent urgent surgical repair of such complications. It is of vital importante that the patient knows the existente of such complications and so obtain a written consent.

Key words:
Lumbar dise herniation
Surgery
Perforation
Intestine
Vascular

Artículo

Opciones para acceder a los textos completos de la publicación Neurocirugía
Socio
Socio de la Sociedad Española de Neurocirugía

Si es la primera vez que accede a la web puede obtener sus claves de acceso poniéndose en contacto con Elsevier España en suscripciones@elsevier.com o a través de su teléfono de Atención al Cliente 902 88 87 40 si llama desde territorio español o del +34 932 418 800 (de 9 a 18h., GMT + 1) si lo hace desde el extranjero.

Si ya tiene sus datos de acceso, clique aquí.

Si olvidó su clave de acceso puede recuperarla clicando aquí y seleccionando la opción "He olvidado mi contraseña".

Suscriptor
Suscriptor de la revista

Si ya tiene sus datos de acceso, clique aquí.

Si olvidó su clave de acceso puede recuperarla clicando aquí y seleccionando la opción "He olvidado mi contraseña".
Suscribirse
Suscribirse a:

Neurocirugía

Comprar
Comprar acceso al artículo

Comprando el artículo el PDF del mismo podrá ser descargado

Precio 19,34 €

Comprar ahora
Contactar
Teléfono para suscripciones e incidencias
De lunes a viernes de 9h a 18h (GMT+1) excepto los meses de julio y agosto que será de 9 a 15h
Llamadas desde España
932 415 960
Llamadas desde fuera de España
+34 932 415 960
Email
Idiomas
Neurocirugía
Opciones de artículo
Herramientas
es en

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?