Lumbar Hernia of the Abdominal Wall Following Iliac Crest Bone Harvest and Extreme Lateral Interbody Fusion (XLIF) via a Single Surgical Incision: A Case Report.

Abstract

Lumbar hernia following extreme lateral interbody fusion (XLIF) with iliac crest bone harvest is an uncommon but clinically relevant complication. A man in his 70s presented with left flank discomfort and a bulge 3 years after XLIF for lumbar spinal canal stenosis, performed via a route using the left anterior superior iliac spine. CT showed herniation of the descending colon through an abdominal wall defect. Laparoscopic intraperitoneal onlay mesh repair was undertaken with nerve-sparing fixation. Recovery was uneventful, and no recurrence or postoperative neuropathic pain was observed at 6 months. This case underscores the potential for abdominal wall weakening when XLIF is combined with iliac crest harvest and the value of laparoscopic repair with nerve-sparing fixation. Meticulous fascial closure and long-term follow-up may reduce the risk of delayed lumbar hernia.