title: A rare postoperative complication of anterior lower thoracic instrumentation: diaphragmatic laceration with hemothorax.
abstract: To highlight the importance of preventing visceral injury due to prominent anterior implants at the spinal column.
  
  
  
  A 52-year-old man with cord compression was treated with a T9/10 discectomy and instrumented fusion via a right thoracotomy and trans-pleural approach. Postoperatively, he had improved lower limb numbness. However, after a bout of coughing, there was sudden increase in chest drain output, hemodynamic instability and massive fluid collection in the right chest cavity.
  
  
  
  Emergency re-exploration of the thoracotomy was performed and a 6 cm laceration of the right postero-medial diaphragm was identified as the bleeding source and was found to be in close proximity with the locking nut of the anterior implants. The laceration was repaired and a soft synthetic patch was used to cover the implants. Postoperatively, the hemothorax resolved and the patient recovered from the neurological deficit.
  
  
  
  Prevention of diaphragmatic injury can be performed using lower profile and less sharp-edged implants. Implant coverage with a soft synthetic material is necessary if unable to perform direct repair of the parietal pleura over the implants.
authors.affiliation: Department of Orthopaedics and Traumatology, Queen Mary Hospital, The University of Hong Kong, Pokfulam Road, Hong Kong, SAR, China.
authors.forename: Yat Wa
authors.identifier: 0000-0002-7052-0875
authors.initials: YW
authors.lastname: Wong
authors.affiliation: Department of Orthopaedics and Traumatology, Queen Mary Hospital, The University of Hong Kong, Pokfulam Road, Hong Kong, SAR, China. cheungjp@hku.hk.
authors.forename: Jason Pui Yin
authors.initials: JPY
authors.lastname: Cheung
authors.affiliation: Department of Orthopaedics and Traumatology, Queen Mary Hospital, The University of Hong Kong, Pokfulam Road, Hong Kong, SAR, China.
authors.forename: Keith Dip Kei
authors.initials: KDK
authors.lastname: Luk
authors.affiliation: Department of Orthopaedics and Traumatology, Queen Mary Hospital, The University of Hong Kong, Pokfulam Road, Hong Kong, SAR, China.
authors.forename: Kenneth Man Chee
authors.initials: KMC
authors.lastname: Cheung
mesh_terms: D003964:Diaphragm / Q000293:injuries* / Q000601:surgery; D017586:Diskectomy / Q000009:adverse effects*; D006491:Hemothorax / Q000209:etiology / Q000601:surgery*; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D022125:Lacerations / Q000209:etiology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology / Q000601:surgery*; D011184:Postoperative Period; D013117:Spinal Cord Compression / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D013123:Spinal Fusion / Q000009:adverse effects*; D013908:Thoracotomy / Q000009:adverse effects
keywords: Anterior spinal fusion; Diaphragm; Hemothorax; Parietal pleura