title: Vertebral body fracture after TLIF: a new complication.
abstract: The transforaminal posterior approach (TLIF) procedure was first described in 1982. Current literature indicates its equality in outcomes for fusion constructs as other anterior-posterior procedures. As a procedure becomes more popular and is more frequently performed the types and number of complications that occur increase. We report on a two case series that underwent TLIF. Both patients had satisfactory postoperative imaging, but presented later with coronal plane vertebral body fractures in the caudal vertebral body of the TLIF construct. We believe the complication may be related to: (a) unrecognized fracture of the endplate during cage impaction; (b) overloading the endplates by maximizing the lordosis achieved by using the reverse jackknife position on a Jackson table; (c) underlying mineral bone disease in patients. As the TLIF procedure increases in popularity, caution should be exercised to avoid the same potential complications.
  
  
  
  To describe a potential complication with the TLIF procedure.
  
  
  
  Case report.
  
  
  
  2.
  
  
  
  Revision surgery.
  
  
  
  Case series.
  
  
  
  Caudal vertebral body fracture is a potential complication after TLIF.
  
  
  
  TLIF procedures can result in an unstable vertebral body fracture potentially necessitating revision decompression & stabilization. We recommend extra caution in patients with mineral bone disease, as technical errors can be magnified.
authors.affiliation: Department of Orthopaedic Surgery, University of Pennsylvania, 3400 Spruce Street 2 Silverstein, Philadelphia, PA, 19104, USA.
authors.forename: Philip A
authors.initials: PA
authors.lastname: Saville
authors.affiliation: Department of Orthopaedic Surgery, University of Pennsylvania, 3400 Spruce Street 2 Silverstein, Philadelphia, PA, 19104, USA.
authors.forename: Jason B
authors.initials: JB
authors.lastname: Anari
authors.affiliation: Department of Orthopaedic Surgery, University of Pennsylvania, 3737 Market Street- 7th Floor, Philadelphia, PA, 19104, USA.|Department of Neurologic Surgery, University of Pennsylvania, 3737 Market Street- 7th Floor, Philadelphia, PA, 19104, USA.
authors.forename: Harvey E
authors.initials: HE
authors.lastname: Smith
authors.affiliation: Department of Orthopaedic Surgery, Comprehensive Spine Center, University of Pennsylvania, 235 South 8th Street, Philadelphia, PA, 19107, USA. Vincent.arlet@uphs.upenn.edu.|Department of Neurologic Surgery, University of Pennsylvania, 235 South 8th Street, Philadelphia, PA, 19107, USA. Vincent.arlet@uphs.upenn.edu.
authors.forename: Vincent
authors.initials: V
authors.lastname: Arlet
mesh_terms: D005260:Female; D006801:Humans; D008141:Lordosis / Q000601:surgery; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000293:injuries / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D065289:Pedicle Screws; D011859:Radiography; D012086:Reoperation; D016103:Spinal Fractures / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D013123:Spinal Fusion / Q000009:adverse effects* / Q000379:methods; D013168:Spondylolisthesis / Q000000981:diagnostic imaging / Q000601:surgery; D014057:Tomography, X-Ray Computed
keywords: Lumbar fusion; Revision surgery; TLIF; Vertebral fracture