Delayed Abdominal Pseudohernia in Young Patient After Lateral Lumbar Interbody Fusion Procedure: Case Report

To describe a rare complication of the extreme lateral interbody fusion technique.

Lateral lumbar interbody fusion (LLIF) is a minimally invasive technique that has achieved great reputation among spine surgeons because of its advantages over other procedures. However, complication rates of this technique have not been definitively assessed so far.

A 44-year-old male smoker, presenting with pseudoarthrosis of a previous posterior stabilization, underwent an LLIF procedure. The operation was uneventful, and an appropriate functional recovery was achieved by 2 months after surgery. Nevertheless, 5 months after surgery, the patient developed pulmonary tuberculosis and a mass in the proximity of the LLIF incision appeared. This mass was finally diagnosed as abdominal pseudohernia and had to be surgically repaired.

Abdominal pseudohernia is a rare complication of LLIF procedures. The interest of the present case is 3-fold: 1) it is the first delayed case of abdominal pseudohernia after an LLIF procedure; 2) it is the first case described in a young patient in whom risk factors have been identified and discussed; and 3) it is the first case that did not resolve spontaneously and required surgical repair. This exceptional complication must be borne in the mind of the spine surgeon when using the LLIF technique, and special precautions, such as laxatives or respiratory physiotherapy, apart from meticulous atraumatic dissection and closure of the abdominal wall and specific intraoperative monitoring, should be taken in high-risk patients to prevent it.