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Case Reports
. 2008 Sep;466(9):2271-5.
doi: 10.1007/s11999-008-0318-0. Epub 2008 Jun 11.

Case reports: splenic rupture after anterior thoracolumbar spinal fusion through a thoracoabdominal approach

Benton E Heyworth  1 , Joseph H Schwab, Oheneba B Boachie-Adjei
Affiliations
Case Reports

Case reports: splenic rupture after anterior thoracolumbar spinal fusion through a thoracoabdominal approach

Benton E Heyworth et al. Clin Orthop Relat Res. 2008 Sep.

Abstract

The anterior approach in spinal deformity surgery has increased in popularity in recent years. The thoracoabdominal approach to the thoracolumbar spine is associated with numerous possible complications, including injury to vital intraabdominal structures in close proximity to the area of exposure, such as the spleen. We describe the case of a 44-year-old woman who underwent an emergent exploratory laparotomy for progressive abdominal pain and hemodynamic instability that revealed splenic rupture two days after single-stage anterior spinal fusion with instrumentation for thoracolumbar kyphoscoliosis. Because the suspected etiology of the splenic hemorrhage was related to retraction, surgeons using the anterior approach should consider intermittent release of retractors and inspection of intraabdominal structures. Splenic rupture should be considered as part of the differential diagnosis for patients with hemodynamic instability after anterior approaches to the thoracolumbar spine.

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Figures

Fig. 1
Fig. 1
A preoperative anteroposterior scoliosis spine radiograph shows the patient’s coronal plane deformity.
Fig. 2
Fig. 2
A preoperative lateral scoliosis spine radiograph shows the patient’s sagittal plane deformity.
Fig. 3
Fig. 3
An abdominal CT scan obtained on postoperative Day 1 revealed an intracapsular hematoma (arrow) adjacent to the spleen (triangle), with extracapsular extension into the abdominal cavity.
Fig. 4
Fig. 4
A postoperative anteroposterior scoliosis spine radiograph shows bony fusion with instrumentation, level shoulders, a level pelvis, and no evidence of coronal decompensation. The persistent thoracic curve of approximately 35° is consistent with our expectations for selective thoracolumbar fusion, and is thought to be necessary for the patient to maintain coronal balance.
Fig. 5
Fig. 5
A postoperative lateral scoliosis spine radiograph shows bony fusion with instrumentation and no evidence of sagittal decompensation.
See this image and copyright information in PMC

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