PDF(Pubmed)
Abstract：
BACKGROUND: The prone lateral approach to lumbar spine surgery is known to have a multitude of potential complications, including damage to neurovascular structures, surrounding viscera, and intra-abdominal structures near the surgical site. However, iatrogenic injury to the spleen following prone lateral lumbar discectomy and arthrodesis as a potential complication has not yet been described in the literature.
METHODS: The authors present the case of a 71-year-old female with a history of L3-S1 laminectomy and L3-5 arthrodesis who underwent a prone lateral discectomy of L2-3 with arthrodesis of the endplates for chronic lower-back pain. On postoperative day 1, the patient developed hypotension unresponsive to pressor medications, significant abdominal pain, and anemia requiring 2 transfusions. Bedside ultrasound revealed free fluid in the abdomen. She then underwent an exploratory laparotomy for splenic injury.
CONCLUSIONS: Although rare, splenic rupture should be considered as part of the differential diagnosis for patients with hemodynamic instability after lateral surgical approaches to the lumbar spine. Any patient with evidence of hypotension, anemia, and/or abdominal pain following lumbar surgery should be evaluated for splenic injury with an abdominal computed tomography scan and considered for surgical intervention. https://thejns.org/doi/10.3171/CASE23639.
METHODS: The authors present the case of a 71-year-old female with a history of L3-S1 laminectomy and L3-5 arthrodesis who underwent a prone lateral discectomy of L2-3 with arthrodesis of the endplates for chronic lower-back pain. On postoperative day 1, the patient developed hypotension unresponsive to pressor medications, significant abdominal pain, and anemia requiring 2 transfusions. Bedside ultrasound revealed free fluid in the abdomen. She then underwent an exploratory laparotomy for splenic injury.
CONCLUSIONS: Although rare, splenic rupture should be considered as part of the differential diagnosis for patients with hemodynamic instability after lateral surgical approaches to the lumbar spine. Any patient with evidence of hypotension, anemia, and/or abdominal pain following lumbar surgery should be evaluated for splenic injury with an abdominal computed tomography scan and considered for surgical intervention. https://thejns.org/doi/10.3171/CASE23639.
摘要：
背景：已知腰椎侧入路手术有许多潜在的并发症，包括神经血管结构的损伤,周围的内脏，和手术部位附近的腹内结构。然而,在倾向于外侧腰椎间盘切除术和关节固定术后，脾脏的医源性损伤作为潜在的并发症尚未在文献中描述。
方法：作者介绍了一名71岁的女性，有L3-S1椎板切除术和L3-5关节固定术的病史，该患者接受了L2-3俯卧外侧椎间盘切除术并进行终板关节固定术治疗慢性下腰痛。术后第1天，患者出现低血压，对升压药物无反应，严重的腹痛，和贫血需要2次输血。床边超声显示腹部有游离液体。然后，她接受了脾损伤的剖腹探查术。
结论：虽然罕见，对于腰椎侧位手术后血流动力学不稳定的患者，应将脾破裂作为鉴别诊断的一部分。任何有低血压证据的病人,贫血,腰椎手术后和/或腹痛应通过腹部计算机断层扫描评估脾损伤，并考虑进行手术干预。https://thejns.org/doi/10.3171/CASE23639.
方法：作者介绍了一名71岁的女性，有L3-S1椎板切除术和L3-5关节固定术的病史，该患者接受了L2-3俯卧外侧椎间盘切除术并进行终板关节固定术治疗慢性下腰痛。术后第1天，患者出现低血压，对升压药物无反应，严重的腹痛，和贫血需要2次输血。床边超声显示腹部有游离液体。然后，她接受了脾损伤的剖腹探查术。
结论：虽然罕见，对于腰椎侧位手术后血流动力学不稳定的患者，应将脾破裂作为鉴别诊断的一部分。任何有低血压证据的病人,贫血,腰椎手术后和/或腹痛应通过腹部计算机断层扫描评估脾损伤，并考虑进行手术干预。https://thejns.org/doi/10.3171/CASE23639.
