title: Hemothorax caused by the trocar tip of the rod inserter after minimally invasive transforaminal lumbar interbody fusion: case report.
abstract: Minimally invasive surgery (MIS) for transforaminal lumbar interbody fusion (MIS-TLIF) is widely used for lumbar degenerative diseases. In the paper the authors report a unique case of a hemothorax caused by the trocar tip of the rod inserter after MIS-TLIF. A 61-year-old woman presented with thigh pain and gait disturbance due to weakness in her lower right extremity. She was diagnosed with a lumbar disc herniation at L1-2 and the MIS-TLIF procedure was performed. Immediately after surgery, the patient's thigh pain resolved and she remained stable with normal vital signs. The next day after surgery, she developed severe anemia and her hemoglobin level decreased to 7.6 g/dl, which required blood transfusions. A chest radiograph revealed a hemothorax. A CT scan confirmed a hematoma of the left paravertebral muscle. A chest tube was placed to treat the hemothorax. After 3 days of drainage, there was no active bleeding. The patient was discharged 14 days after surgery without leg pain or any respiratory problems. This complication may have occurred due to injury of the intercostal artery by the trocar tip of the rod inserter. A hemothorax after spine surgery is a rare complication, especially in the posterior approach. The rod should be caudally inserted in the setting of the thoracolumbar spine.
authors.affiliation: Department of Orthopaedic Surgery, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan.
authors.forename: Keishi
authors.initials: K
authors.lastname: Maruo
authors.affiliation: Department of Orthopaedic Surgery, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan.
authors.forename: Toshiya
authors.initials: T
authors.lastname: Tachibana
authors.affiliation: Department of Orthopaedic Surgery, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan.
authors.forename: Shinichi
authors.initials: S
authors.lastname: Inoue
authors.affiliation: Department of Orthopaedic Surgery, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan.
authors.forename: Fumihiro
authors.initials: F
authors.lastname: Arizumi
authors.affiliation: Department of Orthopaedic Surgery, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan.
authors.forename: Shinichi
authors.initials: S
authors.lastname: Yoshiya
mesh_terms: D004322:Drainage; D005260:Female; D006491:Hemothorax / Q000209:etiology* / Q000601:surgery*; D006801:Humans; D007049:Iatrogenic Disease; D007405:Intervertebral Disc Displacement / Q000601:surgery*; D008159:Lumbar Vertebrae / Q000601:surgery*; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000295:instrumentation*; D013123:Spinal Fusion / Q000295:instrumentation*; D014057:Tomography, X-Ray Computed
keywords: MIS = minimally invasive surgery; TLIF = transforaminal lumbar interbody fusion; complication; hemothorax; minimally invasive transforaminal lumbar interbody fusion; rod inserter; spine surgery; upper lumbar disc herniation