Unstable Lumbar Vertebral Body Fracture During Total Hip Arthroplasty Using the Anterolateral Spine Approach in Diffuse Idiopathic Skeletal Hyperostosis: A Case Report and Literature Review.

This case report describes a 72-year-old man with diffuse idiopathic skeletal hyperostosis who sustained a rare unstable lumbar vertebral body fracture during total hip arthroplasty (THA) using the anterolateral supine approach. Despite a successful THA, the patient developed severe postoperative back pain, leading to the diagnosis of a lumbar vertebral fracture. Prompt posterior spinal fusion effectively relieved the pain. This report emphasizes recognizing high-risk patients, such as those with diffuse idiopathic skeletal hyperostosis complicated by obesity or kyphosis, before THA, and underscores the need for careful perioperative management and intraoperative positioning to reduce stress on the lumbar spine.