Bowel injury in lumbar spine surgery: a review of the literature

Abstract

Although rarely documented in the medical literature, bowel perforation injury can be a severe complication of spine surgery. Our goal was to review current literature regarding this complication and study possible methods of avoidance. We conducted a literature search in the PubMed database between January 1960 and March 2016 using the terms abrasion, bowels, bowel, complication, injury, intestine, intra-abdominal sepsis/shock, perforation, lumbar, spine, surgery, visceral. Diagnostic criteria, outcomes, risk factors, surgical approach, and treatment strategy were the parameters extracted from the search results and used for review. Thirty-one patients with bowel injury were recognized in the literature. Bowel injury was more frequent in patients who underwent lumbar discectomy and microdiscectomy (18 of 31 patients, 58.1%). Minimally invasive surgery and lateral techniques involving fusions accounted for 10 of the reported cases (32.3%). Finally, 2 cases (6.5%) were reported in conjunction with sacrectomies and 1 case (3.2%) with posterior fusion plus anterior longitudinal ligament (ALL) release. Diagnosis was made mostly by clinical signs/symptoms of acute abdominal pain, post-surgical wound infection, and abscess or enterocutaneous fistulas. Significant risk factors for postoperative bowel injury were complex surgical anatomy, medical history of previous abdominal surgeries or infections, irradiation before surgery, errors related to surgical technique, lack of surgical experience, and instrumentation failure. The overall mortality rate from bowel injury was 12.9% (4 of 31 patients). The overall morbidity rate was 87.1% (27 of 31 patients). According to our review of the literature, bowel injury is linked to significant morbidity and mortality. It can be prevented with meticulous pre-surgical planning. When it occurs, timely treatment reduces the risks of morbidity and mortality.

Perspective on the true incidence of bowel perforations occurring with extreme lateral lumbar interbody fusions. How should they be treated?

“…For multiple series, the incidence of BPs attributed to XLIF/MI XLIF ranged between 0.03% to 12.5%; this left us questioning the true incidence of this surgical error [ Table 1 ]. [ 2 , 7 , 9 , 15 , 17 , 19 , 21 , 22 ] Specifically, BPs occurred in one case report, and with higher numbers of cases reported in other clinical series [ Table 1 ]. [ 2 , 5 , 7 , 9 , 15 , 17 , 19 , 21 , 22 ] In 2015, Balsano et al .…”

“…[ 7 , 10 , 15 , 16 , 21 , 22 ] Whatever the true frequency of BP with XLIF/MI XLIF, it is most critical that spine surgeons recognize that new postoperative peritoneal symptoms/signs of BPS so that general surgery can be immediately consulted to both diagnose, and potentially treat this medical error in a timely fashion. [ 19 , 22 ] Delays in diagnosing any type of BP are associated with high mortality rates ranging from 11.1-23%. [ 3 , 4 ] Notably, specific mortality rates for BP occurring in patients undergoing XLIF/MI XLIF ranged from 9.09% (1/11 BP in 13,004 XLIF patients) to 12.9% (4/31 BP occurring in a series of 18 patients following diskectomies/microdiskectomies, and 10 lateral procedures including XLIF).…”

“…[ 3 , 4 ] Notably, specific mortality rates for BP occurring in patients undergoing XLIF/MI XLIF ranged from 9.09% (1/11 BP in 13,004 XLIF patients) to 12.9% (4/31 BP occurring in a series of 18 patients following diskectomies/microdiskectomies, and 10 lateral procedures including XLIF). [ 19 , 22 ]…”

Cómo afrontar esta complicación: migración intraoperatoria de la caja anterior en L5-S1 resuelta con una técnica de fusión lumbar híbrida

“…Iatrogenic perforation of ALL during L5-S1 discectomy with the collateral damage of abdominal viscera such as bowel and the left common iliac artery and vein, with fatal prognosis, has been reported in the literature 8,9 .…”

Intraoperative Kirschner Wire Migration during Robotic Minimally Invasive Spine Surgery

“…Common complications of spine surgery involve the potential for significant blood loss, as well as those related to prone positioning [1]. Injuries to organs in close proximity to the spine have also been reported, and include the heart [2], lungs [3], aorta [4], spleen [5], liver [6], and bowel [7] to name a few. Recent advances in robotic technology have resulted in an increasing number of these procedures with a minimally invasive approach utilizing robotic technology, which is reported to have increased accuracy compared to traditional open spine procedures.…”