Nature abhors a vaccuum: Invagination of the small intestine into the lumbar disc space after a spinal fusion operationopen access
- Authors
- Lee, Wonho; Boudier-Revéret, Mathieu; Kim, Du Hwan; Chang, Min Cheol
- Issue Date
- Apr-2020
- Publisher
- MDPI AG
- Keywords
- Intervertebral disc; Invagination; Small intestine; Spinal fusion; Spinal instability
- Citation
- Diagnostics, v.10, no.4
- Journal Title
- Diagnostics
- Volume
- 10
- Number
- 4
- URI
- https://scholarworks.bwise.kr/cau/handle/2019.sw.cau/63427
- DOI
- 10.3390/diagnostics10040185
- ISSN
- 2075-4418
2075-4418
- Abstract
- A 77-year-old woman having back pain due to an L2 vertebral body compression fracture took a lumbar spine magnetic resonance imaging (MRI). In MRI, in addition to the L2 vertebral body fracture, invagination of the small intestine into the intervertebral disc space at L5-S1 was found by chance. On a lateral lumbar spinal X-ray, the lordotic angle was markedly increased at the L5-S1 level. Additionally, the L5-S1 disc space had widened. These X-ray findings indicate the segmental instability at L5-S1. The spinal fusion operation on L3-4-5 seems to have resulted in overt mechanical loading on the inferior spinal segment (L5-S1). We think the instability damaged the anterior longitudinal ligament and caused a tear in the anterior portion of the annulus fibrosus. The defect in the L5-S1 intervertebral disc after the tear would have caused the vacuum, which is presumed to have pulled the patient's small intestine into the empty space within the L5-S1 intervertebral disc. Although intervertebral invagination of intra-abdominal structures is not common, clinicians should be aware of the possibility of this complication in patients who have spinal segmental instability. © 2020 by the authors.
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