• Patric Garcia, Antonios Pizanis, Alexander Massmann, Birgit Reischmann, Markus Burkhardt, Georgios Tosounidis, Hauke Rensing, and Tim Pohlemann.
• Department of Trauma, Hand, and Reconstructive Surgery, Saarland University Hospital, Homburg/Saar, Germany. chpgar@uniklinikum-saarland.de
• Spine. 2009 May 1; 34 (10): E371-5.

Study DesignCase report and clinical discussion.ObjectiveA rare case of air passage into multiple body compartments after thoracoscopic minimally invasive spine surgery is described.Summary Of Background DataIn recent years, there is growing interest in thoracoscopic minimally invasive spine surgery for the treatment of thoracic and lumbar spine fractures. Severe complications due to the operative procedure are rare.MethodsWe present a case of a 73-year-old woman who developed bilateral pneumothoraces, pneumomediastinum, pneumoperitoneum, pneumoretroperitoneum, and subcutaneous emphysema after thoracoscopic anterior stabilization of a Th12 fracture.ResultsThe operative procedure was completed without any obvious intraoperative complications. Routine made postoperative radiograph of the chest revealed a pneumothorax on the right side, bilateral subphrenic free air, and bilateral supraclavicular air. Subsequently, a CT scan showed bilateral pneumothoraces, pneumomediastinum, pneumoperitoneum, pneumoretroperitoneum and a supraclavicular subcutaneous emphysema. Bronchoscopy, esophagogastroduodenoscopy, and laryngoscopy showed no hollow organ injury or any other pathologic changes. Intraabdominal free air and pneumothoraces could not be detected on thoracic radiographs after 2 days. The patient remained cardiopulmonary stable throughout the hospital course.ConclusionThis report documents a rare case of air passage into multiple body compartments after thoracoscopic-assisted treatment of a spinal fracture, which has not yet been described previously. After exclusion of a tracheo-bronchial and hollow organ injury the process was self-limiting. To avoid this complication, special care should be taken to evacuate all intrathoracal air at the end of the endoscopic procedure.

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