Perforation of the sigmoid colon due to intradiscal spacer dislocation

Abstract

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.

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

“…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).…”

“…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).…”

“…Time to diagnosis was categorized as intraoperative ( (24,25,28,30,34), and more than 1 year after surgery (4 of 31 patients, 12.9%) (13,21,27,33). One article did not specify the time of bowel injury (26).…”

“…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.…”

A case report of a rare complication of bowel perforation in extreme lateral interbody fusion

“…Bowel injuries are a rare complication of anterior lumbar spinal procedures [6][7][8][9][10][11], but can occur in any lumbar procedure, even posterior approaches [12]. The XLIF procedure is a well-recognized alternative to direct anterior interbody fusion and has many relevant benefits over conventional approaches, with relatively a low rate of complications [1,3,[13][14][15][16][17][18][19], though the risk of bowel injury, while low, does exist.…”