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- Title
A rare postoperative complication of anterior lower thoracic instrumentation: diaphragmatic laceration with hemothorax.
- Authors
Wong, Yat; Cheung, Jason; Luk, Keith; Cheung, Kenneth; Wong, Yat Wa; Cheung, Jason Pui Yin; Luk, Keith Dip Kei; Cheung, Kenneth Man Chee
- Abstract
<bold>Purpose: </bold>To highlight the importance of preventing visceral injury due to prominent anterior implants at the spinal column.<bold>Methods: </bold>A 52-year-old man with cord compression was treated with a T9/10 discectomy and instrumented fusion via a right thoracotomy and trans-pleural approach. Postoperatively, he had improved lower limb numbness. However, after a bout of coughing, there was sudden increase in chest drain output, hemodynamic instability and massive fluid collection in the right chest cavity.<bold>Results: </bold>Emergency re-exploration of the thoracotomy was performed and a 6 cm laceration of the right postero-medial diaphragm was identified as the bleeding source and was found to be in close proximity with the locking nut of the anterior implants. The laceration was repaired and a soft synthetic patch was used to cover the implants. Postoperatively, the hemothorax resolved and the patient recovered from the neurological deficit.<bold>Conclusions: </bold>Prevention of diaphragmatic injury can be performed using lower profile and less sharp-edged implants. Implant coverage with a soft synthetic material is necessary if unable to perform direct repair of the parietal pleura over the implants.
- Subjects
THORACIC vertebrae; HEMOTHORAX; DISCECTOMY; DIAPHRAGM (Anatomy); SPINAL fusion; SPINAL cord compression; THORACOTOMY; DISEASES; TRAUMA surgery; DIAPHRAGM injuries; INTERVERTEBRAL disk displacement; POSTOPERATIVE period; SURGICAL complications; WOUNDS &; injuries; DISEASE complications; SURGERY
- Publication
European Spine Journal, 2017, Vol 26, p146
- ISSN
0940-6719
- Publication type
journal article
- DOI
10.1007/s00586-016-4932-3