Vertebral body fractures after transpsoas interbody fusion procedures

Spine J. 2011 Nov;11(11):1068-72. doi: 10.1016/j.spinee.2011.07.020. Epub 2011 Sep 1.


Background context: Although the frequency of transpsoas lumbar interbody fusion procedures has increased in recent years, complication reports remain scarce in the literature.

Purpose: To present four cases of vertebral body fracture after transpsoas interbody fusion procedures in nonosteoporotic patients without significant trauma and discuss relevant biomechanical factors.

Study design: Case series and literature review.

Patient sample: Patients 1 and 2 were obese men who underwent one- and two-level transpsoas interbody fusion procedures and subsequently experienced coronal plane fracture. Patients 3 and 4 were elderly women who underwent multilevel transpsoas interbody fusion procedures and experienced L5 compression fracture.

Results: Patients 2 and 3 were treated nonsurgically after fracture. The fractures healed uneventfully; however, Patient 3 developed a flat back syndrome. Patient 1 underwent posterior instrumented fusion and had solid bridging bone above and below the fracture. Patient 4 was treated with vertebroplasty. Factors potentially contributing to these fractures were discussed.

Conclusions: Fracture can occur after transpsoas lumbar interbody fusion, even in nonosteoporotic patients. Factors, such as intraoperative end-plate breach, subsidence, compression by lateral screws, and cage rolling, could contribute to the development of fractures after transpsoas interbody fusion.

Publication types

  • Case Reports

MeSH terms

  • Aged
  • Female
  • Humans
  • Lumbar Vertebrae / injuries*
  • Lumbar Vertebrae / surgery
  • Male
  • Middle Aged
  • Postoperative Complications / diagnostic imaging
  • Postoperative Complications / etiology*
  • Radiography
  • Spinal Fractures / diagnostic imaging
  • Spinal Fractures / etiology*
  • Spinal Fusion / adverse effects*
  • Spinal Fusion / methods*