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Indications for total disc replacement (TDR) may include implant loosening, malposition, displacement, early wear, and infection. Each indication is likely to require different preoperative planning, testing, and strategies. Preoperative planning is the first and most important step in performing a TDR revision. An organized approach reduces operative time, minimizes risks, decreases stress, and increases the success rate. Primary revision of a failed total disc arthroplasty can be planned as a posterior fusion, leaving the TDR device in place, but an unstable anterior column may require retrieval and revision of the interbody device. An anterior revision approach is associated with significant risk due to scarring and adhesions resulting from the primary procedure, making mobilization of the vessels very difficult, especially at the L4-5 bifurcation. The authors describe a new alternative for retrieval and revision of a TDR device. They present the details of two cases of TDR device revision in which they performed a minimally invasive extreme-lateral interbody fusion to effect a safer access route that avoids vascular structures and the creation of scar tissue.

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