• Spine J · Feb 2013

    Case Reports

    Contralateral psoas seroma after transpsoas lumbar interbody fusion with bone morphogenetic protein-2 implantation.

    • Fadi Taher, Darren R Lebl, Alexander P Hughes, and Federico P Girardi.
    • Division of Spine Surgery, Department of Orthopedic Surgery, Hospital for Special Surgery, 535 East 70th St, New York, NY 10021, USA. fadi.taher@gmail.com
    • Spine J. 2013 Feb 1;13(2):e1-5.

    Background ContextThe lateral transpsoas approach to interbody fusion of the lumbar spine (lateral lumbar interbody fusion [LLIF]) with recombinant human bone morphogenetic protein-2 (BMP-2) augmentation has been increasingly performed in recent years. Potential side effects and adverse sequelae of BMP-2 in the acute setting remain to be fully elucidated.PurposeTo review the literature for reports of complications related to BMP-2 implantation in lumbar spinal surgery and present a case of a contralateral psoas muscle seroma after LLIF with BMP-2 implantation.Study DesignCase report and literature review.MethodsThe PubMed database was searched for articles related to adverse events to BMP-2 in lumbar spinal surgery. We report the case of a 57-year-old woman who underwent routine right-sided transpsoas approach for LLIF with the use of BMP-2 at our institution and developed a left-sided psoas muscle fluid accumulation 2 weeks postoperatively.ResultsNo reports of complications contralateral to an LLIF approach attributable to an inflammatory response to BMP-2 were identified in the English literature. In the presented patient, a large (4.2×6.5×2.7 cm) left-sided sterile intramuscular psoas fluid collection was seen on a magnetic resonance imaging study obtained on postoperative day 14. At a 6-month follow-up, left-sided L5 radiculopathy resulting in 4/5 foot drop was confirmed by electromyography. The patient reported here represents the only case of a contralateral psoas seroma with suspected association to BMP-2 utilization in LLIF encountered at our institution.ConclusionsA serous psoas muscle fluid accumulation after BMP-2 implantation may rarely occur contralateral to the surgical approach for LLIF. Further characterization of complications related to BMP-2 implantation after lumbar spinal surgery will help guide preoperative informed decision making and the management of this unusual postoperative adverse event.Copyright © 2013 Elsevier Inc. All rights reserved.

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