Applying the Mini-Open Anterolateral Lumbar Interbody Fusion with Self-Anchored Stand-Alone Polyetheretherketone Cage in Lumbar Revision Surgery

Abstract

The author retrospectively studied twenty-two patients who underwent revision lumbar surgeries using ALLIF with a self-anchored stand-alone polyetheretherketone (PEEK) cage. The operation time, blood loss, and perioperative complications were evaluated. Oswestry disability index (ODI) scores and visual analog scale (VAS) scores of leg and back pain were analyzed preoperatively and at each time point of postoperative follow-up. Radiological evaluation including fusion, disc height, foraminal height, and subsidence was assessed. The results showed that the ALLIF with a self-anchored stand-alone PEEK cage is safe and effective in revision lumbar surgery with minor surgical trauma, low access-related complication rates, and satisfactory clinical and radiological results.

The comparison between anterior and posterior approaches for removal of infected lumbar interbody cages and a proposal regarding the use of endoscope-assisted technique

“…Another approach through the pathway of XLIF has gained popularity in revision surgery for avoiding the complications of traditional exposures [ 14 ]. The incidence of vascular injury and neural injury is lower with this approach than with the anterior and posterior approaches due to XLIF allowing a pathway to the anterior lumbar spine by splitting through the psoas muscle, thus reducing manipulation of the aorta and vena cava [ 14 , 19 ]. Other approaches have also been applied for cage removal and fusion, such as OLIF, a psoas-preserving access to the revision level via anterior oblique retroperitoneal approach, or laparoscopic surgery to remove migrated cages in the retroperitoneal space [ 19 , 20 ].…”

Anterior lumbar interbody fusion (ALIF) as an option for recurrent disc herniations: a systematic review and meta-analysis

“…It is interesting to note that two of the included studies (Kuang et al and Lee et al) were also observational studies that looked at ALIF but not specifically in recurrent disc herniation, but in revision lumbar surgery. This heterogeneity not only exists in the sample populations being analysed in this paper but also exists within the ALIF intervention itself which can be undertaken in a variety of ways, with or without the use of self-anchoring cages (28), percutaneous pedicle screw fixation (29) and the utilisation of the mini-open approach (28,30,33). Another limitation is that the correct diagnosis of recurrent disc herniation as well as the appropriate surgical treatment option is an ongoing challenge for surgeons and clinicians.…”

“…After exclusion of duplicate or irrelevant references, 18 potentially relevant articles were retrieved. After detailed evaluation of these articles, 7 studies remained for assessment, including a total of 181 patients undergoing ALIF for treatment of recurrent disc herniations (27)(28)(29)(30)(31)(32)(33). All of the included 7 studies were observational and retrospective studies ( Table 1).…”

“…All of the included 7 studies were observational and retrospective studies ( Table 1). Only four studies reported mean follow-up equal of greater than 24 months (27)(28)(29)33).…”

“…Perioperative outcomes from the seven studies the overall range of perioperative complications was 0.079% (95% CI, 0.021-0.137%; I 2 =62.58%; P=0.014) ( Figure 2A). Three studies reported no perioperative complications (31)(32)(33), two studies reported only one or two (27,30), while six or more complications were reported in the other two studies (28,29). Subsidence was the most frequently reported complication.…”