title: Rectocutaneous fistula and nonunion after TranS1 axial lumbar interbody fusion L5-S1 fixation: case report.
abstract: The authors report a case of rectal injury, rectocutaneous fistula, and pseudarthrosis after a TranS1 axial lumbar interbody fusion (AxiaLIF) L5-S1 fixation. The TranS1 AxiaLIF procedure is a percutaneous minimally invasive approach to transsacral fusion of the L4-S1 vertebral levels. It is gaining popularity due to the ease of access to the sacrum through the presacral space, which is relatively free from intraabdominal and neurovascular structures. This 35-year-old man had undergone the procedure for the treatment of degenerative disc disease. The patient subsequently presented with fever, syncope, and foul-smelling gas and bloody drainage from the surgical site. A CT fistulagram and flexible sigmoidoscopy showed evidence of rectocutaneous fistula, which was managed with intravenous antibiotic therapy and bowel rest with total parenteral nutrition. Subsequent studies performed 6 months postoperatively revealed evidence of pseudarthrosis. The patient's rectocutaneous fistula symptoms gradually subsided, but his preoperative back pain recurred prompting a revision of his L5-S1 spinal fusion.
authors.affiliation: Department of Orthopaedics, Wayne State University, Taylor, MI 48180, USA. gsiegel@med.wayne.edu
authors.forename: Geoffrey
authors.initials: G
authors.lastname: Siegel
authors.forename: Nilesh
authors.initials: N
authors.lastname: Patel
authors.forename: Rakesh
authors.initials: R
authors.lastname: Ramakrishnan
mesh_terms: D000328:Adult; D019980:Amoxicillin-Potassium Clavulanate Combination / Q000008:administration & dosage; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D000077727:Ertapenem; D006801:Humans; D055959:Intervertebral Disc Degeneration / Q000601:surgery*; D007431:Intraoperative Complications / Q000382:microbiology / Q000473:pathology / Q000628:therapy; D008159:Lumbar Vertebrae / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D008297:Male; D011542:Pseudarthrosis / Q000209:etiology* / Q000601:surgery; D012003:Rectal Fistula / Q000178:diet therapy / Q000188:drug therapy / Q000209:etiology*; D012007:Rectum / Q000293:injuries*; D012086:Reoperation / Q000379:methods; D012447:Sacrum / Q000601:surgery*; D012812:Sigmoidoscopy; D013123:Spinal Fusion / Q000009:adverse effects*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D047090:beta-Lactams / Q000008:administration & dosage
chemical_list: D000900:Anti-Bacterial Agents; D047090:beta-Lactams; D019980:Amoxicillin-Potassium Clavulanate Combination; D000077727:Ertapenem