Abdominal Flank Bulging after Lateral Retroperitoneal Approach: A Case Report

Area of Science:

• Spinal surgery
• Minimally invasive procedures
• Neurosurgery

Background:

• The lateral transpsoas approach is utilized for spinal fusion, offering benefits like reduced muscle disruption and faster recovery.
• While generally safe, rare complications can occur, impacting patient outcomes.
• Abdominal flank bulging is an under-recognized complication associated with this surgical technique.

Observation:

• A 59-year-old male presented with back and leg pain, diagnosed with spinal stenosis and instability.
• Surgical intervention included L2 corpectomy, L3-4 direct lateral interbody fusion (DLIF), and posterior fusion with T11 rib resection.
• Postoperatively, the patient developed a painful left abdominal flank bulge, exacerbated by physical activities.

Findings:

• Computed tomography (CT) scans revealed left abdominal flank bulging and thinning of the abdominal musculature.
• The complication is hypothesized to stem from denervation of abdominal muscles due to injury of the T11 intercostal nerves during the lateral approach.
• This contrasts with the generally low complication rates reported for the lateral transpsoas procedure.

Implications:

• This case highlights a rare but significant complication of the lateral transpsoas approach, emphasizing the need for awareness among spine surgeons.
• Potential iatrogenic injury to intercostal nerves should be considered when evaluating flank bulging post-surgery.
• Further research may be warranted to explore preventative strategies and management options for this specific complication.