Vertebral body fractures after transpsoas interbody fusion procedures

Abstract 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.