Acute rib fracture caused by preoperative positioning for direct lateral interbody fusion: A case report

Rationale: Degenerative spondylolisthesis is defined as forward slippage of a vertebra with respect to the underlying vertebra and is associated with the induction of lumbar canal stenosis. The use of anterior column support for degenerative lumbar conditions has been well documented. Direct lateral interbody fusion (DLIF) gains access via a lateral approach through the retroperitoneal fat and psoas muscle. It avoids many of the access-related complications yet comes with its own risks and limitations. The location of the iliac wing precludes exposure of the L5–S1 disc space and may make L4–5 surgery difficult. Therefore, accurate preoperative patient positioning is essential. Patient concerns: A 71-year-old female with a body mass index (BMI) of 39.2 kg/m2 (height 155.9 cm, weight 79.5 kg) presented with lumbar pain radiating to the left lower limb. She complained of neurologic claudication with more than 100 m ambulation. Diagnosis: Plain standing view on spine radiography revealed L4–5 spondylolisthesis and disc-space narrowing. Magnetic resonance imaging (MRI) revealed severe L4–5 bilateral foraminal stenosis. After the first surgery, simple rib cage radiography was performed to examine the source of her right-sided flank pain and it revealed acute fracture of the right ninth and tenth ribs. Interventions: The patient was laterally positioned on the table in an extreme bending position. The intervertebral cage was inserted in the L4–5 disc space...
Source: Medicine - Category: Internal Medicine Tags: Research Article: Clinical Case Report Source Type: research