Early migration of bone graft causing sigmoid colon perforation after trans-foraminal lumbar interbody fusion.

BACKGROUND: Tran foraminal lumbar interbody fusion (TLIF) is a well accepted and standard technique of achieving spinal fusion using pedicle screws, cage and bone graft. We are presenting here a case of L4-L5 lumbar canal stenosis managed with TLIF that presented with sigmoid colon perforation due to bone graft migration 4 days after surgery.

CASE REPORT: A 35 years old female underwent open TLIF (from right side) with decompression for L4-L5 lumbar canal stenosis. On 4th post op day she started having abdominal pain and distension. After radiograph reveled gas under diaphragm emergency laparotomy was done and 1 by 1 cm sigmoid colon perforation seen near recto-sigmoid junction. Bony spicules with sharp edges were seen embedded inside the perforation.

DISCUSSION: The purpose of this case report is to present a rare complication and to raise awareness and high index of suspicion among spine surgeons for prevention, early detection and treatment.