title: Case report: incisional hernia as a complication of extreme lateral interbody fusion.
abstract: BACKGROUND
  Minimal access surgery is becoming more popular for spinal fusion because of a lower theoretical risk of complications and shorter postoperative recovery period, compared with the traditional open approach. The lateral approach uses retroperitoneal transpsoas access to the vertebra, obviating the need for an approach surgeon and minimizing muscular disruption, thus allowing a quicker recovery. Initial reports of the lateral transpsoas procedure described few complications. However, a number of complications have subsequently been documented. To our knowledge, there has not been a description of an incisional hernia after this approach.
  
  
  OBJECTIVE
  To report the rare complication of an incisional hernia after a minimal access lateral transpsoas approach for lumbar interbody fusion.
  
  
  METHODS
  Case report.
  
  
  METHODS
  We reviewed the hospital charts, radiographs, and intraoperative photographs of a patient who underwent a minimally invasive lateral approach lumbar spine fusion with a subsequent incisional hernia that necessitated laparoscopic repair.
  
  
  RESULTS
  A 75-year-old woman with a history of low back and left lower extremity pain with radiographic evidence of foraminal stenosis and degenerative spondylolisthesis underwent a successful L4-L5 discectomy with an extreme lateral interbody fusion via a retroperitoneal transpsoas approach. This was supplemented with a posterior minimally invasive surgery instrumented fusion from L4 to L5. The patient reported significant improvement in symptoms on initial follow-up, however, complained of a prominence over her incision 4 weeks later. An incisional hernia was diagnosed and subsequently repaired laparoscopically, from which the patient recovered uneventfully.
  
  
  CONCLUSIONS
  Postoperative incisional hernia after extreme lateral interbody fusion is a complication that has not been previously described in the literature but is one that spine surgeons must recognize. This case may prompt surgeons to use a more posterior approach to avoid this complication. Additionally, direct repair of the transversalis fascia is critical to avoiding this complication.
authors.affiliation: University of Minnesota Medical School, 420 Delaware St SE, Minneapolis, MN 55455, USA.
authors.forename: Timothy V
authors.initials: TV
authors.lastname: Galan
authors.forename: Vivek
authors.initials: V
authors.lastname: Mohan
authors.forename: Eric O
authors.initials: EO
authors.lastname: Klineberg
authors.forename: Munish C
authors.initials: MC
authors.lastname: Gupta
authors.forename: Rolando F
authors.initials: RF
authors.lastname: Roberto
authors.forename: Joshua P
authors.initials: JP
authors.lastname: Ellwitz
mesh_terms: D000368:Aged; D017586:Diskectomy / Q000009:adverse effects*; D005260:Female; D006555:Hernia, Ventral / Q000175:diagnosis / Q000209:etiology*; D006801:Humans; D008159:Lumbar Vertebrae / Q000473:pathology / Q000601:surgery; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects*; D011183:Postoperative Complications / Q000209:etiology*; D016658:Psoas Muscles / Q000601:surgery; D011859:Radiography; D013123:Spinal Fusion / Q000009:adverse effects*; D013130:Spinal Stenosis / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D013168:Spondylolisthesis / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D016896:Treatment Outcome