title: Mesenteric ischemia following the correction of adult spinal deformity: case report.
abstract: Vascular complications are an important adverse event that can be associated with spinal reconstructive surgery. Direct injury of vessels, or indirect traction or compression of vessels, can cause both arterial and venous injury. Indirect compression of the mesenteric vessels is a well-recognized complication of bracing and surgical care of children with spinal deformity (superior mesenteric artery syndrome), but the complication is not common or well recognized in the adult population with spinal deformity. The purpose of this case report is to detail the case of postoperative mesenteric ischemia in a 63-year-old man in whom a posterior approach was used to perform spinal deformity correction. Preoperatively, the patient had had significant lumbar hypolordosis. The reconstructive surgery with the use of posterior-based osteotomies resulted in a shortening of the posterior column of the spine but a relative lengthening of structures anterior to the spine. The significant lordosis achieved by the surgery led to an acute worsening of the mesenteric stenosis suffered by the patient. He required a vascular surgery intervention to restore perfusion to the bowel. Recognition of severe vasculopathy is important in anticipating potential postoperative vascular insufficiency. This case report will inform surgeons and clinicians to have a higher index of suspicion for the exacerbation of vascular insufficiency, including mesenteric pathology, in patients undergoing surgery that involves significant realignment of the spine. Preoperative recognition of vascular insufficiency and treatment of symptomatic disease may limit the occurrence of postoperative vascular complications in spinal reconstructive surgery.
authors.affiliation: Department of Orthopaedic Surgery, University of California, San Francisco, California.
authors.forename: Krishn
authors.initials: K
authors.lastname: Khanna
authors.affiliation: Department of Orthopaedic Surgery, University of California, San Francisco, California.
authors.forename: Sigurd H
authors.initials: SH
authors.lastname: Berven
mesh_terms: D006801:Humans; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery*; D008198:Lymph Nodes / Q000601:surgery; D008297:Male; D065666:Mesenteric Ischemia / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D008875:Middle Aged; D011183:Postoperative Complications / Q000000981:diagnostic imaging; D013121:Spinal Curvatures / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D013123:Spinal Fusion / Q000009:adverse effects* / Q000379:methods; D013736:Testicular Neoplasms / Q000150:complications / Q000532:radiotherapy / Q000601:surgery
keywords: CTA = CT angiography; SMA = superior mesenteric artery; SVA = sagittal vertical axis; adult spinal deformity; lumbar; mesenteric ischemia; vascular complications