Traumatic Vertebral Fracture in a Patient With Transforaminal Lumbar Interbody Fusion: A Rare Complication

Abstract

Transforaminal lumbar interbody fusion (TLIF) offers the potential benefits of anterior and posterior column decompression and fusion. Pseudarthrosis and infection are among the most common perioperative complications. Vertebral fracture after TLIF is a rare and unusual complication. A 74-year-old female underwent L3-5 TLIF for lumbar spondylolisthesis that caused back pain and neurogenic claudication. She recovered well after surgery. However, she subsequently experienced progressive back pain and recurrent claudication after a fall. Elongated anterior-posterior length of the L5 body with progressive L5-S1 listhesis was observed in the serial radiographic follow-ups. The CT scan revealed complicated fracture lines crossing the L5 body. Further extended fixation was performed for decompression and reconstruction of the lumbosacral alignment. Although vertebral fracture after TLIF is a rare complication, a high index of suspicion is the key to early diagnosis, preferably with CT scans, for patients with traumatic accidents after TLIF surgery.

Bilateral L5 pedicle fracture with L5–S1 spondylolisthesis after single-level L4–5 posterior lumbar interbody fusion: illustrative case

“…Chiang et al 14 reported a case of L5 vertebral fracture and L5–S1 spondylolisthesis at 3 months after L3–5 transforaminal lumbar interbody fusion (TLIF). Their case was similar to ours in terms of fracture type and the complication of L5–S1 spondylolisthesis.…”

“…[7][8][9][10] The remaining three cases had pedicle fractures within the fusion range without implant removal, but all of them had experienced middle to long posterolateral fusion (PLF) using a hook-and-rod system with no use of pedicle screws. [11][12][13] Chiang et al 14 reported a case of L5 vertebral fracture and L5-S1 spondylolisthesis at 3 months after L3-5 transforaminal lumbar interbody fusion (TLIF). Their case was similar to ours in terms of fracture type and the complication of L5-S1 spondylolisthesis.…”