Mark R Foster1. 1. Cherry Way Orthopedics, Pittsburgh, Pennsylvania 15219, USA. Cherryway@pol.net
Abstract
STUDY DESIGN: The case of a complication sustained by an obese patient undergoing a lumbar spine fusion is reported. OBJECTIVES: To minimize further complications by reporting on this case complicated by rhabdomyolysis in a lumbar fusion, and to include a review of the literature. SUMMARY OF BACKGROUND DATA: Rhabdomyolysis has been described as a clinical syndrome initially characterized by darker urine, muscle pain, and weakness from prolonged muscle compression, as in intoxicated patients or after a seizure. Rhabdomyolysis and myoglobinuria have also been reported in the prolonged positions of some surgical procedures. METHODS: A 40-year-old man developed progressively incapacitating lumbar pain above a previous fusion from L4 to S1, with a severe decline in his functional capacities and a large weight gain. Revision surgery removing the previous instrumentation and performing an instrumented fusion from L2 to L4 was complicated by rhabdomyolysis. RESULTS: After an unremarkable surgery, this patient was hemodynamically unstable when transferred from the operating table to the supine position and required aggressive treatment of severe rhabdomyolysis, which has not previously been reported in this setting. CONCLUSION: Patients undergoing lumbar spine surgery require decompression of the abdomen, and in this case, a Jackson table was used. Unfortunately, his abdominal girth, even on a Jackson table, was not fully decompressed and resulted in this complication. Further consideration should be given to modifications of positioning for morbidly obese patients.
STUDY DESIGN: The case of a complication sustained by an obesepatient undergoing a lumbar spine fusion is reported. OBJECTIVES: To minimize further complications by reporting on this case complicated by rhabdomyolysis in a lumbar fusion, and to include a review of the literature. SUMMARY OF BACKGROUND DATA: Rhabdomyolysis has been described as a clinical syndrome initially characterized by darker urine, muscle pain, and weakness from prolonged muscle compression, as in intoxicated patients or after a seizure. Rhabdomyolysis and myoglobinuria have also been reported in the prolonged positions of some surgical procedures. METHODS: A 40-year-old man developed progressively incapacitating lumbar pain above a previous fusion from L4 to S1, with a severe decline in his functional capacities and a large weight gain. Revision surgery removing the previous instrumentation and performing an instrumented fusion from L2 to L4 was complicated by rhabdomyolysis. RESULTS: After an unremarkable surgery, this patient was hemodynamically unstable when transferred from the operating table to the supine position and required aggressive treatment of severe rhabdomyolysis, which has not previously been reported in this setting. CONCLUSION:Patients undergoing lumbar spine surgery require decompression of the abdomen, and in this case, a Jackson table was used. Unfortunately, his abdominal girth, even on a Jackson table, was not fully decompressed and resulted in this complication. Further consideration should be given to modifications of positioning for morbidly obesepatients.
Authors: Brian J Minnema; Peter C Neligan; Nasir A Quraishi; Michael G Fehlings; Suma Prakash Journal: J Gen Intern Med Date: 2008-03-19 Impact factor: 5.128
Authors: A Sousa; J A Paiva; S Fonseca; F Raposo; L Valente; D Vyas; O Ribeiro; R Pinto Journal: Eur J Trauma Emerg Surg Date: 2012-10-25 Impact factor: 3.693