“Nature Abhors a Vaccuum”: Invagination of the Small Intestine into the Lumbar Disc Space After a Spinal Fusion Operation
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...
| Main Authors: | , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
MDPI AG
2020-03-01
|
| Series: | Diagnostics |
| Subjects: | |
| Online Access: | https://www.mdpi.com/2075-4418/10/4/185 |
| _version_ | 1797626529216200704 |
|---|---|
| author | Wonho Lee Mathieu Boudier-Revéret Du Hwan Kim Min Cheol Chang |
| author_facet | Wonho Lee Mathieu Boudier-Revéret Du Hwan Kim Min Cheol Chang |
| author_sort | Wonho Lee |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-03-11T10:11:41Z |
| format | Article |
| id | doaj.art-53bab79577534af2874bad6f864e3518 |
| institution | Directory Open Access Journal |
| issn | 2075-4418 |
| language | English |
| last_indexed | 2024-03-11T10:11:41Z |
| publishDate | 2020-03-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Diagnostics |
| spelling | doaj.art-53bab79577534af2874bad6f864e35182023-11-16T14:27:44ZengMDPI AGDiagnostics2075-44182020-03-0110418510.3390/diagnostics10040185“Nature Abhors a Vaccuum”: Invagination of the Small Intestine into the Lumbar Disc Space After a Spinal Fusion OperationWonho Lee0Mathieu Boudier-Revéret1Du Hwan Kim2Min Cheol Chang3Department of Radiology, Topspine Hospital, Daegu 41931, KoreaDepartment of Physical Medicine and Rehabilitation, Centre hospitalier de l’Université de Montréal, Montreal, H2W 1T8, CanadaDepartment of Physical Medicine and Rehabilitation, College of Medicine, Chung-Ang University, Seoul 06973, KoreaDepartment of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Daegu 42415, KoreaA 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.https://www.mdpi.com/2075-4418/10/4/185invaginationsmall intestinespinal fusionspinal instabilityintervertebral disc |
| spellingShingle | Wonho Lee Mathieu Boudier-Revéret Du Hwan Kim Min Cheol Chang “Nature Abhors a Vaccuum”: Invagination of the Small Intestine into the Lumbar Disc Space After a Spinal Fusion Operation Diagnostics invagination small intestine spinal fusion spinal instability intervertebral disc |
| title | “Nature Abhors a Vaccuum”: Invagination of the Small Intestine into the Lumbar Disc Space After a Spinal Fusion Operation |
| title_full | “Nature Abhors a Vaccuum”: Invagination of the Small Intestine into the Lumbar Disc Space After a Spinal Fusion Operation |
| title_fullStr | “Nature Abhors a Vaccuum”: Invagination of the Small Intestine into the Lumbar Disc Space After a Spinal Fusion Operation |
| title_full_unstemmed | “Nature Abhors a Vaccuum”: Invagination of the Small Intestine into the Lumbar Disc Space After a Spinal Fusion Operation |
| title_short | “Nature Abhors a Vaccuum”: Invagination of the Small Intestine into the Lumbar Disc Space After a Spinal Fusion Operation |
| title_sort | nature abhors a vaccuum invagination of the small intestine into the lumbar disc space after a spinal fusion operation |
| topic | invagination small intestine spinal fusion spinal instability intervertebral disc |
| url | https://www.mdpi.com/2075-4418/10/4/185 |
| work_keys_str_mv | AT wonholee natureabhorsavaccuuminvaginationofthesmallintestineintothelumbardiscspaceafteraspinalfusionoperation AT mathieuboudierreveret natureabhorsavaccuuminvaginationofthesmallintestineintothelumbardiscspaceafteraspinalfusionoperation AT duhwankim natureabhorsavaccuuminvaginationofthesmallintestineintothelumbardiscspaceafteraspinalfusionoperation AT mincheolchang natureabhorsavaccuuminvaginationofthesmallintestineintothelumbardiscspaceafteraspinalfusionoperation |