PLIF, cirrhosis

51-year-old female for consideration of Posterior Lumbar Interbody Fusion for acute pain management

Background

  • Osteomyelitis and Discitis – current inpatient for pain management
  • Multiple vertebral crush fractures
  • E-coli bacteraemia – resolving
  • No nerve root impingement/neurological symptoms

Issues:

  • COPD – current smoker. No formal spirometry
  • Severe pulmonary hypertension and Tricuspid Regurgitation. Likely Cor-pulmonale
  • Exercise tolerance – 50m on flat
  • Recent ex IVDU with untreated Hepatitis C
  • Childs-Pugh 3 Cirrhosis. Diagnosed following an upper GIH, gastroscopy showed varices.
  • No regular gastroenterology follow-up or treatment

Discussion

Perioperative Optimisation

  • Consensus that this is a high-risk patient and procedure.
  • Undefined bleeding risk, need to assess preoperatively
  • Gastroenterology advice should be sought preoperatively

Less invasive Surgical Options

  • Main advantage to PLIF is analgesia, no neurological symptoms
  • Neurosurgeon feels that vertebrae will self-fuse in coming weeks to months and results will be similar
  • On discussion of co-morbidities surgical team have decided the procedure is currently too high risk for the indication

Plan:

  • Delay currently
  • Neurosurgical team to organise Gastro consult