Aretakis Alexander C, Farrell James P, Ou-Yang David C, Kleck Christopher J
Department of Spine Surgery, University of Colorado, Aurora, CO, USA.
J Spine Surg. 2024 Mar 20;10(1):144-151. doi: 10.21037/jss-23-87. Epub 2024 Jan 18.
For patients undergoing long-construct fusion surgeries, simultaneous sacroiliac joint (SIJ) fusion is a growing trend in spine surgery. Some options for posterior SIJ fusion include 3D-printed triangular titanium implants or self-harvesting SIJ screws. Both implants require fixation within the sacrum and ileum. Fat embolism syndrome is a rare but known complication of lumbar pedicle instrumentation but has never been reported in association with SIJ fusion, regardless of implant type. We report the first two known cases of fat embolism associated with placement of SIJ fusion devices during long construct posterior spine fusion.
Case 1-a 50-year-old female with multiple previous spine surgeries complicated by osteomyelitis/diskitis that was successfully eradicated, underwent T10-pelvis posterior spinal fusion (PSF), L4 pedicle-subtracting-osteotomy, and bilateral SIJ fusion. During implantation of each SIJ fusion device, the patient's hemodynamic status deteriorated necessitating vasopressor support, intravenous fluid bolus, and hyperventilation, but quickly resolved. The case was completed without further issue, and she had an uneventful post-operative course. Case 2-a 71-year-old female with a past medical history of ankylosing spondylitis, previous L2-L5 PSF, rheumatoid arthritis on chronic steroids, underwent a T9-pelvis PSF, bilateral SIJ fusion, L4 pedicle subtraction osteotomy, T10-L1 Smith Peterson osteotomies. After implantation of the second SIJ fusion device, she became hypotensive and tachycardic, pulses were absent, and cardiopulmonary resuscitation was initiated. Pulses returned quickly, the index surgery was terminated, and she was transferred to the intensive care unit (ICU). In the ICU she was quickly weaned off the ventilator on post-operative day 1. On post-operative day 4, the patient returned to the operating room for completion of the surgery and had an extended, but uneventful, recovery afterwards.
We report on the first two known cases of fat embolism syndrome occurring immediately after implantation of SIJ fusion devices. Spine surgeons should be aware of this rare, but potentially fatal, complication. Collaboration with the anesthesia team and optimization of the patient's hemodynamic status prior to implantation may help prevent catastrophic complications.
对于接受长节段融合手术的患者，同时进行骶髂关节（SIJ）融合在脊柱外科手术中呈增长趋势。后路SIJ融合的一些选择包括3D打印三角形钛植入物或自体采集的SIJ螺钉。两种植入物都需要固定在骶骨和髂骨内。脂肪栓塞综合征是腰椎椎弓根器械植入术一种罕见但已知的并发症，但无论植入物类型如何，与SIJ融合相关的情况从未有过报道。我们报告了首例两例已知的与长节段后路脊柱融合术中SIJ融合装置植入相关的脂肪栓塞病例。
病例1——一名50岁女性，既往有多次脊柱手术史，并发骨髓炎/椎间盘炎，已成功根除，接受了T10至骨盆后路脊柱融合术（PSF）、L4椎弓根截骨术和双侧SIJ融合术。在植入每个SIJ融合装置期间，患者的血流动力学状态恶化，需要血管活性药物支持、静脉推注液体和过度通气，但很快得到缓解。该病例顺利完成，术后过程平稳。病例2——一名71岁女性，有强直性脊柱炎病史，既往有L2至L5 PSF，因类风湿关节炎长期服用类固醇，接受了T9至骨盆PSF、双侧SIJ融合术、L4椎弓根截骨术、T10至L1 Smith Peterson截骨术。在植入第二个SIJ融合装置后，她出现低血压和心动过速，脉搏消失，开始进行心肺复苏。脉搏很快恢复，手术终止，她被转入重症监护病房（ICU）。在ICU，她在术后第1天迅速脱机。术后第4天，患者返回手术室完成手术，之后恢复过程延长但平稳。
我们报告了首例两例已知的在SIJ融合装置植入后立即发生的脂肪栓塞综合征病例。脊柱外科医生应意识到这种罕见但可能致命的并发症。与麻醉团队合作并在植入前优化患者的血流动力学状态可能有助于预防灾难性并发症。
