{"id":"9920053a-1093-497a-8e74-ced4ddd36fbd","slug":"perspective-on-the-true-incidence-of-bowel-perforations-occurring-with-extreme-lateral-lumbar-interbody-fusions-how-should-they-be-treated","title":"Perspective on the true incidence of bowel perforations occurring with extreme lateral lumbar interbody fusions. How should they be treated?","authors":["Nancy E. Epstein"],"abstract":"Background: What is the risk of bowel perforation (BP) with open or minimally invasive (MI) extreme lateral lumbar interbody fusion (XLIF)? What is the truth? Further, if peritoneal symptoms/signs arise following XLIF/MI XLIF, it is critical to obtain an emergent consultation with general surgery who can diagnose and treat a potential BP. Literature Review: In multiple series, the frequency of BP ranged markedly from 0.03% (i.e. 1 of 2998 patients), to 0.08% (11/13,004), to 0.5%, to 8.3% (1 in 12 patients), up to 12.5% (1 in 8 patients). BPs attributed to different causes carry high mortality rates varying from 11.1% to 23%. For the 11 (0.08%) BP occurring out of 13,004 patients undergoing XLIF in one series, there was one (9.09%) death due to uncontrolled sepsis. In another series, where 31 BP were identified for multiple lumbar surgical procedures identified through PubMed (1960–2016), including 10 (32.2%) for lateral lumbar surgery including XLIF, the overall mortality rate was 12.9% (4/31). Conclusion: The incidence of BPs occurring following XLIF/MI XLIF procedures ranged from 0.03% to 12.5% in various reports. What is the true incidence of these errors? Certainly, it is more critical that when spine surgeons’ patients develop acute peritoneal symptoms/signs following these procedures, they immediately consult general surgery to both diagnose, and treat potential BP in a timely fashion to avoid the high morbidity (87.1%) and mortality rates (12.9%) attributed to these perforations.","thumbnailUrl":"https://sni-digital-videos.s3.amazonaws.com/articles/9920053a-1093-497a-8e74-ced4ddd36fbd/featured/hero-cropped-1781561831031.jpg","publishDate":"2021-11-23T00:00:00.000Z","doi":"10.25259/SNI_1003_2021","categories":["Spine","Review Article"],"fullTextUrl":"https://surgicalneurologyint.com/wp-content/uploads/2021/11/11239/SNI-12-576.pdf"}