Colon Perforation Caused by Migration of a Bone Graft Following a Posterior Lumbosacral Interbody Fusion Operation

Çakmak, Atıl; Gyedu, Adam; Kepenekçi, İlknur; Ozcan, Cumhur; Ünal, Ali Ekrem

doi:10.1097/brs.0b013e3181bb1bf2

Cited by 10 publications

(17 citation statements)

References 11 publications

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“…In one publication, bowel injury occurred during sacrectomy for tumor removal (34). There were 10 publications in which bowel injury was described after lateral approaches and MIS spinal procedures in the lumbar spine (11,12,(14)(15)(16)21,23,24,27,33). Additionally, one study reported bowel injury after instrumentation failure in a procedure for a spinal deformity (25).…”

Section: Resultsmentioning

confidence: 99%

“…The surgical procedures involved in the bowel injuries were discectomy (13,17,18,26,(30)(31)(32), microdiscectomy (19,20,22,28,29) extreme lateral interbody fusion (XLIF) (11), AxiaLIF (14,15,23,24,33), ALIF (12,21), anterior endoscopic spondylodesis at L5-S1 (27) posterior lumbar interbody fusion (PLIF) (16), posterior spinal fusion-anterior spine release through a retroperitoneal approach (25), and sacrectomy (34). An analysis of the types of surgeries that these patients underwent demonstrated that bowel injury was more frequent in lumbar discectomy and microdiscectomy (18 of 31 patients, 58.1%).…”

Section: Resultsmentioning

confidence: 99%

“…In most cases, bowel injury occurred during surgery and was noted at the time. Three cases of bowel injury were diagnosed postoperatively due to migration of instrumentation (16,21,27). Abrasion of the intestinal wall in one patient was the result of a migrated screw after a lumbosacral AxiaLIF procedure (33).…”

Section: Resultsmentioning

confidence: 99%

“…Acute abdominal pain, hyperemesis, hypotension, and peritonitis with subsequent sepsis were the clinical findings in most patients (17,18,25,28,31). Other clinical findings included haemorrhage (15,34), tenesmus (33), edema, or inflammation at the site of the injury due to communication with the intestine; abscess (14,16,32); and discovering parts of instrumentation in the feces (21,27). Radiological evaluation plus computed tomography (CT) of the abdomen in these cases revealed intra-abdominal fluid and pneumoperitoneum, intestinal fistulas, or abdominal abscesses, and instrumentation close to the gastrointestinal tract.…”

Section: Resultsmentioning

confidence: 99%

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

et al. 2018

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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.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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

et al. 2018

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“…Dislocation may occur posteriorly into the spinal canal [11]. In case of anterior dislocation, the vessels, visceral structures, or nerves may be involved [12,13]. In the case described above, the anterior dislocation of the spacer caused arrosion of the sigmoid colon with perforation and transanal passage of the spacer.…”

Section: S290mentioning

confidence: 99%

Perforation of the sigmoid colon due to intradiscal spacer dislocation

et al. 2011

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A case of late dislocation of a disc spacer L5/S1 with perforation of the sigmoid colon and transanal passage 4 years after implantation is reported. The objective is to describe an uncommon complication of anterior endoscopic spondylodesis L5/S1. To our knowledge, this is the first report on this rare complication. A 39-year-old patient suffering from a spondylolisthesis L5/S1 (Meyerding grade 2) with bilateral lysis L5 was operated with posterior instrumentation L5/S1 and anterior endoscopic insertion of two disc spacers. 4 years after surgery the patient noticed one of the spacers in the toilet. Radiographic examination of the colon with contrast dye revealed a perforation at the distal sigmoid colon. At the lumbosacral junction there was a bony defect at the site of the absent spacer and an anterior dislocation of the second spacer. A partial resection of the colon at the perforation site with end-to-end anastomosis was performed. The second spacer was removed, and the defect was packed with autologous cancellous bone and local antibiotics. The further course was uneventful. 2 weeks postoperatively the patient was discharged without signs of infection. The radiographic examination after 6 months showed healing of the bone graft with bony fusion L5/S1. In case of incomplete or absent bony fusion the dislocation of intradiscal spacers may arise even years after the primary surgery. In consequence periodical radiographic examinations of spinal instrumentations are recommended until complete bony fusion occurred. Unclear abdominal symptoms following anterior spine surgery require immediate examination.

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Anterior graft migration in posterior lumbar interbody fusion: A case report and literature review

Hashimoto,

Hirata,

Tsukamoto

et al. 2023

Clinical Case Reports

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Key Clinical MessageSpine surgeons should be aware of the possibility of anterior displacement of the grafted bone during PLIF and the potential for severe complications that may arise because of such displacement so that preparations can be made for a proper response.AbstractWe report two cases of anterior displacement of the grafted bone after posterior lumbar interbody fusion (Graphical Abstract A‐D). The patients did not require additional surgery. The anterior migration of grafted bone or cage can cause damage to anterior organs and blood vessels. Therefore, a careful surgical procedure is necessary.

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Colon Perforation Caused by Migration of a Bone Graft Following a Posterior Lumbosacral Interbody Fusion Operation

Abstract: We have presented a case whose migrated L4-S1 femur graft led to perforation of the cecum. We recommend that frequent radiologic follow-up should be done in patients at risk to show complications early enough to avert severe consequences.

Cited by 10 publications

References 11 publications

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

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

Perforation of the sigmoid colon due to intradiscal spacer dislocation

Anterior graft migration in posterior lumbar interbody fusion: A case report and literature review

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