Salvage Strategy for Failed Spinal Fusion Surgery Using Lumbar Lateral Interbody Fusion technique: A Technical Note
Sumihisa Orita1), Takao Nakajima2), Kenta Konno1), Kazuhide Inage1), Takeshi Sainoh1), Kazuki Fujimoto1), Jun Sato1), Yasuhiro Shiga1), Hirohito Kanamoto1), Koki Abe1), Masahiro Inoue1), Hideyuki Kinoshita1), Masaki Norimoto1), Tomotaka Umimura1), Yasuchika Aoki3), Junichi Nakamura1), Yusuke Matsuura1), Go Kubota1), Yawara Eguchi1), Richard A. Hynes4), Tsutomu Akazawa5), Miyako Suzuki1), Kazuhisa Takahashi1), Seiji Ohtori1)
1) Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan 2) Department of Orthopedic Surgery, Nippon Medical School, Chiba Hokusoh Hospital, Inzai, Chiba, Japan 3) Department of Orthopaedic Surgery, East Chiba Medical Center, Togane, Chiba, Japan 4) Department of Orthopaedic Surgery, The Back Center Back Pain Spine Surgery, Melbourne, FL, USA 5) Department of Orthopedic Surgery, St. Marianna University, Kawasaki, Kanagawa, Japan
Introduction: Failed spinal fusion surgery sometimes requires salvage surgery when symptomatic, especially with postsurgical decrease in intervertebral disc height followed by foraminal stenosis. For such cases, an anterior approach to lumbar lateral interbody fusion (LLIF) provides safe, direct access to the pathological disc space and a potential improvement in the fusion rate. One LLIF approach, oblique lateral interbody fusion (OLIF), targets the oblique lateral window of the intervertebral discs to achieve successful lateral interbody fusion. The current technical note describes spinal revision surgery using the OLIF procedure. Technical Note: The subjects were patients with leg pain and/or lower back pain derived from decreased intervertebral height followed by foraminal stenosis due to failed spinal fusion surgery. These patients underwent additional OLIF surgery and posterior fusion with no additional posterior direct decompression. Their outcomes were evaluated using the Japanese Orthopaedic Association (JOA) scores at baseline and final follow-up. Bony union was also evaluated using computed tomography images at final follow-up.
Six subjects were evaluated, with two representative cases described in detail. Four patients had an adjacent segment disorder, and the other two patients had pseudarthrosis due to postoperative infection. The mean JOA score improved from 5.7 ± 5.4 to 21.2 ± 2.3, with a mean recovery rate of 65.0%. All cases showed intervertebral bony union. Conclusions: We introduced a salvage strategy for failed posterior spine fusion surgery cases using the OLIF procedure. Patients effectively achieved recovered intervertebral and foraminal height with no additional posterior direct decompression.
January 27, 2018; doi: dx.doi.org/10.22603/ssrr.2017-0035