Complications and strategies for salvage of intervertebral fixation devices

Heim, Stephen E.; Abitbol, Jean Jacques

doi:10.1016/s0030-5898(01)00007-4

Cited by 11 publications

(6 citation statements)

References 7 publications

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“…The discussion regarding implant failure itself is beyond the current report, but the most commonly encountered reasons for failed interbody fusion derive from undersized constructs, single midline constructs, lateral cage placement with nerve root irritation, an anteriorly/posteriorly prominent cage, and pseudarthrosis . We have to mention that the placement of the cage in the current case was far lateral, that is suboptimal and why the subsidence occurred.…”

Section: Discussionmentioning

confidence: 82%

Successful salvage surgery for failed transforaminal lumbosacral interbody fusion using the anterior transperitoneal approach

Hozumi

Orita

Inage

et al. 2016

Clinical Case Reports

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Section: Discussionmentioning

confidence: 82%

Successful salvage surgery for failed transforaminal lumbosacral interbody fusion using the anterior transperitoneal approach

Hozumi

Orita

Inage

et al. 2016

Clinical Case Reports

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“…Complications resulting from the interbody fusion procedures have been well reported since the technique was first described by Harms et al[22] in 1982. These complications, however, have typically involved infection, durotomy, bleeding, malpositioned hardware, or pseudoarthrosis[5,11,17,19,21]. Hardware failure reports have been limited to interbody device migration/subsidence, screw fracture, or rod breakage[18,20,23-25].…”

Section: Discussionmentioning

confidence: 99%

“…Prosthetic allograft interbody spacers are utilized during TLIF procedures to restore anterior column support and disc height in patients with degenerative disc disease and spondylolisthesis[4,8-11]. The demineralized surface of the implant’s allogenic bone provides osteoconductivity to aid in osteogenesis and scaffolding for new bone formation along its surface and successful interbody arthrodesis[12,13].…”

Section: Introductionmentioning

confidence: 99%

Fracture of allograft interbody spacer resulting in post-operative radiculopathy: A case report

Andrews

Rowland

Stirton

et al. 2019

WJO

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BACKGROUND Allograft interbody spacers are utilized during transforaminal lumbar interbody fusion (TLIF) to reestablish anterior column support and disc height. While the TLIF technique offers many improvements over previous surgical methods, instrumentation and bone graft-related complications such as spacer misplacement or migration, screw fracture or misplacement, or rod breakage continue to be reported. The objective of this manuscript is to report on a fractured allograft interbody spacer that displaced into the neural foramen and resulted in impingement on the exiting nerve root that required revision. CASE SUMMARY A 50-year-old male had two-level TLIF with immediate post-operative right L5 radiculopathy. Computed tomography scan demonstrated a fractured allograft interbody spacer that displaced into the right neural foramen and impinged on the exiting L5 nerve root. Revision surgery was performed to remove the broken allograft fragments from the right L5 foramen and the intact portion of the spacer was left in place. The right leg L5 radicular pain resolved. At the last follow up 12 mo after the index procedure, computed tomography scan confirmed sound interbody and posterolateral fusion. CONCLUSION Displacement of broken allograft interbody spacer following TLIF procedures can result in neurological sequelae that require revision. To avoid such an occurrence, the authors recommend allowing sufficient time for the reconstitution of the graft in saline prior to use to decrease brittleness, to use an impactor size that is as close as possible to the spacer size and meticulous inspection of the cortical allograft spacer for any visible imperfection prior to insertion.

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“…The most commonly encountered reasons for failed interbody fusion derive from undersized constructs, single midline constructs, lateral cage placement with nerve root irritation, an anteriorly/posteriorly prominent cage, and pseudarthrosis 12) . LLIF overcomes these issues by inserting a much larger cage in the perpendicular direction to the traditional posterior cage, which greatly reduces the possibility of anterior/posterior prominence and irritation of the spinal nerve and results in a low rate of pseudarthrosis with robust circumference fusion, bridging the bilateral edge of the apophyseal ring (Fig.…”

Section: The Advantages Of Llif Intervertebral Cagesmentioning

confidence: 99%

“…5). The wide contact area of the cage via a wide portal window is extremely effective in revision fusion surgery 12) . This point is extremely important because posterior removal of failed cages from sometimes results in endplate fracture or irregular endplate surface due to excess debridement.…”

Section: The Advantages Of Llif Intervertebral Cagesmentioning

confidence: 99%

Salvage Strategy for Failed Spinal Fusion Surgery Using Lumbar Lateral Interbody Fusion technique: A Technical Note

Orita

Nakajima

Konno

et al. 2018

Spine Surg Relat Res

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Abstract: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.

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Complications and strategies for salvage of intervertebral fixation devices

Cited by 11 publications

References 7 publications

Successful salvage surgery for failed transforaminal lumbosacral interbody fusion using the anterior transperitoneal approach

Successful salvage surgery for failed transforaminal lumbosacral interbody fusion using the anterior transperitoneal approach

Fracture of allograft interbody spacer resulting in post-operative radiculopathy: A case report

Salvage Strategy for Failed Spinal Fusion Surgery Using Lumbar Lateral Interbody Fusion technique: A Technical Note

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