A case of posterior fusion for lumbar burst fracture with antiphospholipid syndrome

<p>Introduction: Antiphospholipid syndrome (APS) has been considered to be one of the highest risk of venous thromboembolism (VTE) which is a severe perioperative complication. We herein present a case of lumbar burst fracture concomitant APS, which was performed by posterior spinal fixation surgery.</p><p>Case Report: A 18-year-old male has been undergoing anti-coagulant treatment for APS for 6 years at another hospital. He was involved in a traffic accident while driving on December 2019 and immediately sustained intolerable low back pain. The cause of persisting pain could not be identified by a primary physician, and then the patient was referred to our hospital. On physical examination, he had severe low back pain around L1 spinous process, but he had no neurological deficits. Plain radiography demonstrated a suspected burst fracture of widening of interpedicular distance at L1 in AP view and protrusion of the posterior wall of the vertebral body at L1 in lateral view. CT revealed 40 % of a bone fragment occupancy rate in the spinal canal, but MRI demonstrated no direct compression of the spinal cord. Prior to surgery, unfractionated heparin was administered intravenously for 7 days. With the patient in the prone position, posterior fixation from T11 to L3 with autologous iliac bone graft supplemented with the synthetic bone graft (b-TCP) was performed. On day 1 post surgery, anticoagulant therapy was immediately resumed, following physical rehabilitation on day 2. The postoperative course was uneventful, and the patient was discharged 2 weeks after surgery.</p><p>Conclusions: APS has a one of the possible disease of causing a catastrophic damage and a poor prognosis due to surgical invasiveness. If abnormal values of platelet and coagulant factors on presurgical testing are detected, it is important to preoperatively investigate aPL in potential APS patients and perform meticulous perioperative anticoagulant therapy to prevent such complications.</p>