Rectocutaneous fistula and nonunion after TranS1 axial lumbar interbody fusion L5–S1 fixation

Case report

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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.

Abbreviations used in this paper:IV = intravenous; TPN = total parenteral nutrition.

Article Information

Address correspondence to: Geoffrey Siegel, M.D., 10000 Telegraph Rd., Department of Medical Education, Taylor, MI 48180. email: gsiegel@med.wayne.edu.

Please include this information when citing this paper: published online June 21, 2013; DOI: 10.3171/2013.5.SPINE11523.

© AANS, except where prohibited by US copyright law.

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Figures

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    Coronal CT images showing a fistula coursing toward the anterior spine (A), contrast around screw (B), contrast within entry point of screw (C), and contrast in fistula in presacral space (D).

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    A: Axial CT image showing tract of rectocutaneous fistula. B: Sagittal CT image showing clear haloing around cage. C: Sagittal T1-weighted MR image showing fluid in the disc space.

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    A and B: Coronal (A) and sagittal (B) CT images obtained 10 months after revision showing solid posterolateral and interbody fusion. C: Metal subtraction image obtained 10 months after revision showing instrumentation and fusion. D: Sagittal MR image obtained 20 months after revission showing stable appearance with no evidence of residual infection.

References

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