Vertebral body fractures after transpsoas interbody fusion procedures

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.