Department of Orthopaedics, Wayne State University, Taylor, MI 48180, USA.
J Neurosurg Spine. 2013 Aug;19(2):197-200. doi: 10.3171/2013.5.SPINE11523. Epub 2013 Jun 21.
The authors report a case of rectal injury, rectocutaneous fistula, and pseudarthrosis after a TranS1 axial lumbar interbody fusion (AxiaLIF) L5-S1 fixation. The TranS1 AxiaLIF procedure is a percutaneous minimally invasive approach to transsacral fusion of the L4-S1 vertebral levels. It is gaining popularity due to the ease of access to the sacrum through the presacral space, which is relatively free from intraabdominal and neurovascular structures. This 35-year-old man had undergone the procedure for the treatment of degenerative disc disease. The patient subsequently presented with fever, syncope, and foul-smelling gas and bloody drainage from the surgical site. A CT fistulagram and flexible sigmoidoscopy showed evidence of rectocutaneous fistula, which was managed with intravenous antibiotic therapy and bowel rest with total parenteral nutrition. Subsequent studies performed 6 months postoperatively revealed evidence of pseudarthrosis. The patient's rectocutaneous fistula symptoms gradually subsided, but his preoperative back pain recurred prompting a revision of his L5-S1 spinal fusion.
作者报告了一例经 Trans1 轴向腰椎椎间融合术（AxiaLIF）L5-S1 固定后直肠损伤、直肠皮肤瘘和假关节形成的病例。Trans1 AxiaLIF 手术是一种经皮微创入路，用于 L4-S1 椎体水平的经骶融合。由于通过 presacral 空间可以轻松进入骶骨，而 presacral 空间相对免受腹腔内和神经血管结构的影响，因此该手术越来越受欢迎。这位 35 岁的男性因退行性椎间盘疾病接受了该手术。随后，患者出现发热、晕厥和从手术部位排出有恶臭的气体和血性分泌物。CT 瘘管造影和乙状结肠镜检查显示存在直肠皮肤瘘，采用静脉抗生素治疗和全肠外营养的肠道休息来进行治疗。术后 6 个月进行的后续研究显示存在假关节的证据。患者的直肠皮肤瘘症状逐渐缓解，但术前的背痛复发，促使对 L5-S1 脊柱融合进行翻修。
