Anterior Extrusion of Bone Graft after Posterior Lumbar Interbody Fusion with development Deep Vein Thrombosis: Case Report and Literature review
Article Sidebar
Main Article Content
Abstract
Background: Anterior bone graft extrusion is a very rare complication. Most patients with this type of extrusion are asymptomatic. Only few studies reported with the development of deep vein thrombosis (DVT) due to anterior bone graft extrusion and the detailed about the management.
Propose: The propose of this study is to report a patient with anterior bone graft extrusion with development of DVT without revision spinal surgery.
Materials and Methods: The authors demonstrated case by describing the patient’s history, physical examination, imaging studies and treatment. We also reviewed and discussed related literatures.
Results: The patients with foraminal stenosis and disc extrusion of L4-S1 was performed posterior decompression and posterior lumbar interbody fusion of L4-S1. Postoperatively, the patient developed left thigh pain and swelling. The diagnosis of proximal DVT at left common iliac vein was confirmed by Doppler ultrasound and 3D CT angiography. The patient was treated with intervention; stent insertion at left common iliac vein, balloon dilatation, Inferior vena cava(IVC) filter, thrombectomy, injection of low molecular weight heparin. The patients showed an improvement in the clinical of radicular pain and thigh swelling.
Conclusion: Proximal DVT due to anterior bone graft extrusion is a very rare complication. The most important clinical symptoms are thigh swelling and pain. We must recognize patient’s early symptoms and give an early diagnosis due to proximal DVT could be develop pulmonary thromboembolism and lead to death. Furthermore, the revision spinal surgery is more complex and associated with severe complications. This study described the management of DVT with nonsurgical approach, such as thrombectomy, common iliac vein stent, IVC filter insertion with an application of anticoagulants without going through revision spinal surgery.
Article Details
References
2. Yoshimoto H, Sato S, Nakagawa I, Hyakumachi T, Yanagibashi Y, Nitta F, et al. Deep vein thrombosis due to migrated graft bone after posterior lumbosacral interbody fusion. Case report. Case report. J Neurosurg Spine 2007; 6: 47-51.
3. Pawar UM, Kundnani V, Nene A. Major vessel injury with cage migration: surgical complication in a case of spondylodiscitis. Spine (Phila Pa 1976) 2010; 35: E663-6.
4. Oh HS, Lee SH, Hong SW. Anterior dislodgement of a fusion cage after transforaminal lumbar interbody fusion for the treatment of isthmic spondylolisthesis. J Korean Neurosurg Soc 2013; 54: 128-31.
5. Villavicencio AT, Nelson EL, Rajpal S, Otalora F, Burneikiene S. Case series of anterior intervertebral graft extrusions in transforaminal lumbar interbody fusion surgeries. World Neurosurg 2016; 85: 130-5.
6. Elias WJ, Nathan ES, Kaptain GJ, Chadduck JB, Whitehill R. Complications of posterior lumbar interbody fusion when using a titanium threaded cage device. J Neurosurg 2000; 93: 45-52.
7. Okuda S, Miyauchi A, Oda T, Haku T, Yamamoto T, Iwasaki M. Surgical complications of posterior lumbar interbody fusion with total facetectomy in 251 patients. J Neurosurg Spine 2006; 4: 304-9.
8. Yang SD, Liu H, Sun YP, Yang DL, Shen Y, Feng SQ, et al. Prevalence and risk factors of deep vein thrombosis in patients after spine surgery: a retrospective case-cohort study. Sci Rep 2015; 5: 11834.
9. Rothenfluh DA, Koenig M, Stokes OM, Behrbalk E, Boszczyk BM. Access-related complications in anterior lumbar surgery in patients over 60 years of age. Eur Spine J 2014; 23 Suppl 1: S86-92.
10. Cox JB, Weaver KJ, Neal DW, Jacob RP, Hoh DJ. Decreased incidence of venous thromboembolism after spine surgery with early multimodal prophylaxis: Clinical article. J Neurosurg Spine 2014; 21: 677-84.
11. Wang TY, Sakamoto JT, Nayar G, Suresh V, Loriaux DB, Desai R, et al. Independent predictors of 30-day perioperative deep vein thrombosis in 1346 consecutive patients after spine surgery. World Neurosurg 2015; 84: 1605-12.
12. Graphat MG, Hayden G, Corinna CZ, Robert TA, Paul SA, Shivanand PL, et al. Venous thromboembolism after thoracic/thoracolumbar spinal fusion. World Neurosurg 2012; 78: 545-52.
13. Lee HM, Suk KS, Moon SH, Kim DJ, Wang JM, Kim NH. Deep vein thrombosis after major spinal surgery: incidence in an East Asian population. Spine (Phila Pa 1976) 2000; 25: 1827-30.
14. Nguyen HV, Akbarnia BA, van Dam BE, Raiszadeh K, Bagheri R, Canale S, et al. Anterior exposure of the spine for removal of lumbar interbody devices and implants. Spine 2006; 31: 2449-53.
15. Fantini GA, Pappou IP, Girardi FP, Sandhu HS, Cammisa FP Jr. Major vascular injury during anterior lumbar spinal surgery: incidence, risk factors, and management. Spine (Phila Pa 1976) 2007; 32: 2751-8.
16. Hamdan AD, Malek JY, Schermerhorn ML, Aulivola B, Blattman SB, Pomposelli FB Jr. Vascular injury during anterior exposure of the spine. J Vasc Surg 2008; 48: 650-4.
17. Gumbs AA, Hanan S, Yue JJ, Shah RV, Sumpio B. Revision open anterior approaches for spine procedures. Spine 2007; 7: 280-5.
18. Mobbs RJ, Phan K, Daly D, Rao PJ, Lennox A. Approach-related complications of anterior lumbar interbody fusion: result of a combined spine and vascular surgical team. Global Spine J 2016; 6: 147-54.
19. Nyamekye I, Merker L. Managemnet of proximal deep vein thrombosis. Phlebology 2012; 27 Suppl 2: 61-72.