Department of Orthopaedics and Traumatology, Zentralklinikum Suhl, Albert-Schweitzer-Str. 2, 98527 Suhl, Germany.
Eur Spine J. 2011 Jul;20 Suppl 2(Suppl 2):S289-93. doi: 10.1007/s00586-011-1696-7. Epub 2011 Feb 1.
A case of late dislocation of a disc spacer L5/S1 with perforation of the sigmoid colon and transanal passage 4 years after implantation is reported. The objective is to describe an uncommon complication of anterior endoscopic spondylodesis L5/S1. To our knowledge, this is the first report on this rare complication. A 39-year-old patient suffering from a spondylolisthesis L5/S1 (Meyerding grade 2) with bilateral lysis L5 was operated with posterior instrumentation L5/S1 and anterior endoscopic insertion of two disc spacers. 4 years after surgery the patient noticed one of the spacers in the toilet. Radiographic examination of the colon with contrast dye revealed a perforation at the distal sigmoid colon. At the lumbosacral junction there was a bony defect at the site of the absent spacer and an anterior dislocation of the second spacer. A partial resection of the colon at the perforation site with end-to-end anastomosis was performed. The second spacer was removed, and the defect was packed with autologous cancellous bone and local antibiotics. The further course was uneventful. 2 weeks postoperatively the patient was discharged without signs of infection. The radiographic examination after 6 months showed healing of the bone graft with bony fusion L5/S1. In case of incomplete or absent bony fusion the dislocation of intradiscal spacers may arise even years after the primary surgery. In consequence periodical radiographic examinations of spinal instrumentations are recommended until complete bony fusion occurred. Unclear abdominal symptoms following anterior spine surgery require immediate examination.
报告一例 L5/S1 椎间盘 spacer 术后 4 年发生迟发性脱位，刺穿乙状结肠和经肛门通道。目的在于描述 L5/S1 前路内镜融合术后一种不常见的并发症。据我们所知，这是首例对此罕见并发症的报道。一名 39 岁患者患有 L5/S1 脊椎滑脱（Meyerding 分级 2 级）伴双侧 L5 溶解，行后路器械固定 L5/S1 及前路内镜插入两个椎间盘 spacer。术后 4 年，患者在厕所发现其中一个 spacer。结肠造影检查显示远端乙状结肠穿孔。在腰骶交界处，缺失 spacer 部位有骨缺损，第二个 spacer 发生前脱位。在穿孔部位行部分结肠切除术并端端吻合术。取出第二个 spacer，并用自体松质骨和局部抗生素填充缺损。随后恢复顺利。术后 2 周，患者无感染迹象出院。术后 6 个月的放射学检查显示 L5/S1 骨移植愈合，骨融合。如果不完全或没有骨融合，即使在初次手术后多年也可能发生椎间盘 spacer 脱位。因此，建议在完全骨融合之前定期进行脊柱器械的放射学检查。前路脊柱手术后出现不明原因的腹部症状需要立即检查。
