Acute Renal Infarction After Lateral Lumbar Interbody Spinal Fusion for Kyphoscoliosis

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• 作者：Sanjeev J. Suratwala ; MD ; FAAOS ; FACS^a ; ^{ssuratwala@northwell.edu" class="auth_mail" title="E-mail the corresponding author} ; MaryAnne Cronin ; MS ; PharmD ; BCPS^b ; Katelyn Kondra ; BS^c ; Vincent Leone ; MD ; FAAOS^a
• 关键词：Renal infarct ; Lateral interbody fusion ; Kyphoscoliosis ; Complications
• 刊名：Spine Deformity
• 出版年：2016
• 出版时间：September 2016
• 年：2016
• 卷：4
• 期：5
• 页码：385-389
• 全文大小：1575 K

文摘

Case report.

Objectives

Case report of acute renal infarction following lateral interbody fusion with posterior instrumentation for adult lumbar kyphoscoliosis.

Summary of Background Data

This is the first reported renal infarction following minimally invasive lateral interbody fusion and posterior spinal instrumentation.

Methods

We report a case of acute renal infarction in a 72-year-old woman following direct lateral interbody fusion (DLIF) with percutaneous pedicle screw and rod fixation from L1 to L5 for correction of kyphoscoliosis. She reported vague abdominal pain on postoperative day (POD) 7. Abdominal ultrasound findings revealed no abnormalities. The patient tolerated a regular diet, improved in rehabilitative modalities, and had stable vital signs. Abdominal computed tomographic (CT) scan on POD 9 for persistent abdominal pain revealed right renal infarction and right renal artery occlusion. The patient was transferred to the ICU for evaluation, where intravenous heparin was administered and no reperfusion was performed. Transesophageal echocardiography on POD 14 revealed moderate diffuse plaque in the descending aorta.

Results

Surgical correction of kyphoscoliosis through DLIF and posterior spinal instrumentation was performed with improvement of deformity. Subsequent acute renal infarction was noted. The patient was discharged home on POD 21. There were no further adverse events up to the 1-year follow-up.

Conclusions

A lateral approach to the anterior lumbar spine may precipitate renal artery occlusion and renal infarction in patients with atherosclerosis. Diagnosis of renal infarction requires a high index of suspicion because the primary complaint may be vague back, flank, and abdominal pain. We emphasize the importance of recognizing potential symptoms early to prevent additional renal injury. Caution should be taken with deformities around the origin of the renal arteries and great vessels, especially in patients with atherosclerosis.

Level of Evidence

Level IV.