Purpose: Vascular complications in lumbar disc surgery are rare, difficult to diagnose and may have serious consequences. We review our experience in eight cases treated in the past 30 years.

Methods: Between 1976 and 2005 we operated on 16,391 cases of vascular pathology, eight for vascular complications after lumbar discectomy (herniated disc), six men and two women aged 36 to 70 (mean 52 years). The symptoms were abdominal pain in four, ischial irradiation in one, episodes of heart failure in one, limb oedema in two, acute haemorrhage in three, abdominal murmur in two. The diagnosis was made during surgery in two cases and immediately postoperative in the third due to severe hypovolemia. The others were diagnosed because of abdominal murmur, limb oedema and suspected abdominal aneurism. Abdominal CT scans and arteriography were performed in five cases. Treatment was surgical, with direct closure in seven cases and interposition of a Dacron aortoiliac prosthesis in the other. No sequelae were seen during follow-up, which lasted a maximum of fifteen years. All the patients returned to normal life and there was no mortality.

Conclusions: Because of the severity and rareness of this complication, few cases have been described in the literature, and its real incidence is therefore unknown. We should think of it whenever there is any unexplained, sustained haemodynamic disorder during lumbar disc surgery or immediately postoperative. Treatment should be immediate.

Introduction.- Some of the recommended alternatives to increase the cementless acetabular cups stability are the plasma sprayed porous coated and HA and the press-fit impaction. The incorporation of three peripheral fins improves final fixation avoiding micromotion at the immediate post operative period. From 1992 we have implanted 4068 cups, the majority of them in primary cases (78%). The rest 22% in revision cases.

Cup characteristics: hemispheric with fins to improve prumary fixation and HA coating; ring-long ystem in common with other Biomet models, reason why liner are interchangeables.

Material and methods.- 4.068 Bihapro cups (Biomet-Merck) were implanted at a multicenter study in three Hospitals, adjoined to the University, between 1992 and 2003. This is a press-fit model with a porous surface coated with HA and three peripheral fins to improve primary fixation and also dome holes to allow the use ob bone screws.

Prymary indication: osteoarthritis (76%), AVN (7%), fractures (8%), dysplasias (3%), rheumatoid arthritis (6%). Surgical approach: lateral (49%), posterolateral (34,2%), anterior (16,8%). Prophylaxis: antitrombotic (LMWH), antibiotic (1st generation cephalosporins), heterotopic ossification (indomethacin).

Results.- Results. 24 patients showed dislocation and 47 % had some degree of periarticular ossification one year alter surgery; the approach used did not show significative differences. The survival study was done using Kaplan-Meier’s curve. The end-point for failure in this study was the need to perform aesptic revision surgery; being the survival at 9 years of 99.49 % (CI 95 % 99.08 – 99.90). Seven cases needed revision surgery (0.3 %); two cases for migration of the cup and five cases for iterative dislocations.

Conclusions.- Acetabular cups with Plasma Spray Porous Coating in combination with HA, results stable at mid term. The supplementary fixation of the three peripheral fins avoids micromotion optimizing long-term fixation.