The anterior approach in spinal deformity surgery has increased in popularity in recent years. The thoracoabdominal approach
to the thoracolumbar spine is associated with numerous possible complications, including injury to vital intraabdominal structures
in close proximity to the area of exposure, such as the spleen. We describe the case of a 44-year-old woman who underwent
an emergent exploratory laparotomy for progressive abdominal pain and hemodynamic instability that revealed splenic rupture
two days after single-stage anterior spinal fusion with instrumentation for thoracolumbar kyphoscoliosis. Because the suspected
etiology of the splenic hemorrhage was related to retraction, surgeons using the anterior approach should consider intermittent
release of retractors and inspection of intraabdominal structures. Splenic rupture should be considered as part of the differential
diagnosis for patients with hemodynamic instability after anterior approaches to the thoracolumbar spine.
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