J Korean Soc Spine Surg.  2018 Mar;25(1):35-39. 10.4184/jkss.2018.25.1.35.

Vertebral Body Fracture after Oblique Lumbar Interbody Fusion in 2 Patients: A Case Report

• Kim SB
• Won YG
• Lee JS
• Ahn JS
• Kang C
• Lee GS

• KMID: 2408306
• DOI: http://doi.org/10.4184/jkss.2018.25.1.35

Abstract

STUDY DESIGN: Although the frequency of the oblique lumbar interbody fusion (OLIF) procedure has increased in recent years, reports on its complications remain rare. We report 2 cases of vertebral fracture after OLIF.
OBJECTIVES
We aimed to report 2 cases of coronal vertebral fracture after an OLIF procedure in non-osteoporotic patients without significant trauma, and to review the complications of OLIF. SUMMARY OF LITERATURE REVIEW: There is a growing but limited literature describing early postoperative complications after OLIF.
MATERIALS AND METHODS
Patient 1 was an obese woman who underwent 2-level OLIF with posterior instrumentation procedures and subsequently experienced 2-level coronal plane fractures. Patient 2 was an elderly man who underwent 3-level OLIF without posterior instrumentation and experienced 1 coronal vertebral fracture. We report vertebral body fracture as a complication of OLIF through these 2 cases.
RESULTS
Patient 1 was treated nonsurgically after the fractures. The fractures healed uneventfully. However, patient 2 underwent posterior instrumented fusion and had a solid bridging bone above and below the fracture. Factors potentially contributing to these fractures are discussed.
CONCLUSIONS
OLIF is an effective procedure for several spinal diseases. However, fracture can occur after OLIF even in non-osteoporotic patients. Factors such as intraoperative end-plate breach, subsidence, cage rolling, and inadequate posterior instrumentation could contribute to the development of fractures after oblique interbody fusion.

Keyword

Oblique lumbar interbody fusion; Coronal vertebral fracture; Complication

MeSH Terms

Aged
Female
Humans
Postoperative Complications
Spinal Diseases

Figure

• 

  Fig. 1. (A) Preoperative and (B) immediate postoperative lateral radiographs of a 60-year-old female patient. (C) Computed tomography scans showing a L3-4 vertebral coronal fracture at 1 week postoperatively. The fracture site showed union at 6 months postoperatively. (D) The fracture site showed union at 6 months postoperatively.

• 

  Fig. 2. (A) Preoperative and (B) immediate postoperative lateral radiographs of a 68-year-old male patient. (C) At 2 weeks postoperatively, a radiograph showed a L4 vertebral body coronal fracture. (D) Additional posterior instrumentation was performed.

Reference

1. Mobbs RJ, Phan K, Malham G, et al. Lumbar interbody fusion: techniques, indications and comparison of interbody fusion options including PLIF, TLIF, MI-TLIF, OLIF/ATP, LLIF and ALIF. J Spine Surg. 2015 Dec; 1(1):2–18. DOI: 10.3978/j.issn.2414-469X.2015.10.05.

2. Hosono N, Namekata M, Makino T, et al. Perioperative complications of primary posterior lumbar interbody fusion for nonisthmic spondylolisthesis: analysis of risk factors. J Neurosurg Spine. 2008 Nov; 9(5):403–7. DOI: 10.3171/SPI.2008.9.11.403.

3. Woods KR, Billys JB, Hynes RA. Technical description of oblique lateral interbody fusion at L1–L5 (OLIF25) and at L5–S1 (OLIF51) and evaluation of complication and fusion rates. Spine J. 2017 Apr; 17(4):545–53. DOI: 10.1016/j.spinee.2016.10.026.

4. Li JX, Phan K, Mobbs R. Oblique lumbar interbody fusion: technical aspects, operative outcomes, and complications. World Neurosurg. 2017 Feb; 98:113–23. DOI: 10.1016/j.wneu.2016.10.074.

5. Abe K, Orita S, Mannoji C, et al. Perioperative complications in 155 patients who underwent oblique lateral interbody fusion surgery: perspectives and indications from a retrospective, multicenter survey. Spine (Phila Pa 1976). 2017 Jan 1; 42(1):55–62. DOI: DOI:10.1097/BRS.0000000000001650.

6. Silvestre C, Mac-Thiong J-M, Hilmi R, et al. Complications and Morbidities of Mini-open Anterior Retroperitoneal Lumbar Interbody Fusion: Oblique Lumbar Interbody Fusion in 179 Patients. Asian Spine J. 2012 Jun; 6(2):89–97. DOI: 10.4184/asj.2012.6.2.89.

7. Dua K, Kepler CK, Huang RC, et al. Vertebral body fracture after anterolateral instrumentation and interbody fusion in two osteoporotic patients. Spine J. 2010 Sep; 10(9):E11–5. DOI: 10.1016/j.spinee.2010.07.007.

8. Brier-Jones JE, Palmer DK, Ĭnceoğlu S, et al. Vertebral body fractures after transpsoas interbody fusion procedures. Spine J. 2011 Nov; 11(11):1068–72. DOI: 10.1016/j.spinee.2011.07.020.

9. Yang KH, King A. Mechanism of facet load transmission as a hypothesis for low-back pain. Spine (Phila Pa 1976). 1984 Sep; 9(6):557–65. DOI: 10.1097/00007632-198409000-00005.

10. Chen L, Yang H, Tang T. Cage migration in spondylolisthesis treated with posterior lumbar interbody fusion using BAK cages. Spine (Phila Pa 1976). 2005 Oct 1; 30(19):2171–5. DOI: 10.1097/01.brs.0000180402.50500.5b.