Splenic rupture following prone lateral discectomy and arthrodesis: illustrative case.

backgroundThe prone lateral approach to lumbar spine surgery is known to have a multitude of potential complications, including damage to neurovascular structures, surrounding viscera, and intra-abdominal structures near the surgical site. However, iatrogenic injury to the spleen following prone lateral lumbar discectomy and arthrodesis as a potential complication has not yet been described in the literature. OBSERVATIONS: The authors present the case of a 71-year-old female with a history of L3-S1 laminectomy and L3-5 arthrodesis who underwent a prone lateral discectomy of L2-3 with arthrodesis of the endplates for chronic lower-back pain. On postoperative day 1, the patient developed hypotension unresponsive to pressor medications, significant abdominal pain, and anemia requiring 2 transfusions. Bedside ultrasound revealed free fluid in the abdomen. She then underwent an exploratory laparotomy for splenic injury. LESSONS: Although rare, splenic rupture should be considered as part of the differential diagnosis for patients with hemodynamic instability after lateral surgical approaches to the lumbar spine. Any patient with evidence of hypotension, anemia, and/or abdominal pain following lumbar surgery should be evaluated for splenic injury with an abdominal computed tomography scan and considered for surgical intervention. https://thejns.org/doi/10.3171/CASE23639.