Spinal instrumentation after transplantation has not been reported before. We report a case of the posterior lumbar interbody fusion (PLIF) after liver transplantation.
A 58-year-old man underwent a cadaveric liver transplantation due to the cirrhosis in 1999. He stopped taking steroid 6 months and Mycophenolate 3 years after the surgery, but he had been taking Cyclosporin and Lamivudine. He could not stand because of the severe low back pain soon after the surgery, but this pain disappeared spontaneously. Nevertheless, not only did low back pain recur but also severe left leg pain appeared. Finally, he could walk only within 100m with a stick. X-photo showed L2 compression fracture and L5 spondylolysis. MRI demonstrated developmental canal stenosis at L3-4 level. He had decreased renal function and diabetes, but his liver function was normal. PLIF with titanium cages at L3-4, L4-5 and L5-6 levels was done in November 2003. Antibiotics were given for two weeks. He recovered from the symptoms completely without any complications.
Spinal instrumentation leads to an increase in the rate of successful fusion and to a decrease the period of patient recovery, but can increase the risk of infection. A transplant patient has a risk of infection because of the immunosuppressants used. As stand-alone PLIF with cages decreases the extent of dissection and local tissue damage, it reduces the risk of infection. In addition, fusion often fails in cases of osteoporosis. Patients with end stage liver disease are prone to develop osteopenia and osteoporosis, and additional bone loss occurs with the use of immunosuppressants and steroids. However, bone mineral density (BMD) turns into the restoration within at least 6months after transplantation.
Stand-alone PLIF can be done safely only if 6months have passed since the transplantation, BMD is normal and the transplanted organ functions well.