Rectocutaneous fistula and nonunion after TranS1 axial lumbar interbody fusion L5-S1 fixation: case report

J Neurosurg Spine. 2013 Aug;19(2):197-200. doi: 10.3171/2013.5.SPINE11523. Epub 2013 Jun 21.


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.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Amoxicillin-Potassium Clavulanate Combination / administration & dosage
  • Anti-Bacterial Agents / administration & dosage
  • Ertapenem
  • Humans
  • Intervertebral Disc Degeneration / surgery*
  • Intraoperative Complications* / microbiology
  • Intraoperative Complications* / pathology
  • Intraoperative Complications* / therapy
  • Lumbar Vertebrae / surgery*
  • Magnetic Resonance Imaging
  • Male
  • Pseudarthrosis / etiology*
  • Pseudarthrosis / surgery
  • Rectal Fistula / diet therapy
  • Rectal Fistula / drug therapy
  • Rectal Fistula / etiology*
  • Rectum / injuries*
  • Reoperation / methods
  • Sacrum / surgery*
  • Sigmoidoscopy
  • Spinal Fusion / adverse effects*
  • Tomography, X-Ray Computed
  • Treatment Outcome
  • beta-Lactams / administration & dosage


  • Anti-Bacterial Agents
  • beta-Lactams
  • Amoxicillin-Potassium Clavulanate Combination
  • Ertapenem