Caudal Vertebral Body Fractures Following Lateral Interbody Fusion in Nonosteoporotic Patients

Background The minimally invasive lateral transpsoas approach for lumbar fusions has become increasingly popular. However, vertebral body fractures have been reported after this procedure, particularly in patients with osteoporosis and patients undergoing multilevel fusions. We evaluated the risk factors for caudal vertebral body fractures in 2 nonosteoporotic patients with single-level disease.

Case Reports Two patients presented with several years' history of incapacitating chronic low back pain and intermittent radicular pain. Diagnostic imaging in both cases demonstrated grade 1 degenerative spondylolisthesis. The patients underwent a lateral transpsoas interbody fusion, with lateral plate fixation in 1 patient and standalone lateral fusion in the other. The operations were performed without any incidents and both patients experienced immediate symptom relief. Both patients returned several weeks later with excruciating low back pain, without any postoperative history of trauma or heavy lifting. Diagnostic imaging in both patients showed a coronal fracture of the inferior vertebral body. The patients underwent urgent revision surgery involving posterior supplementation with pedicle screw and rod constructs and posterolateral fusion.

Conclusion Caudal vertebral body fracture in patients with normal bone quality is a major potential complication after the minimally invasive lateral approach for lumbar fusions. Risk factors may include placement of a lateral plate, the size of the smaller anteroposterior cage, endplate violation, and oblique placement of the interbody cage.