Department of Neurological Surgery and Weill Cornell Medical College, New York-Presbyterian Hospital, New York, New York 10065, USA.
Neurosurg Focus. 2011 Oct;31(4):E17. doi: 10.3171/2011.8.FOCUS11139.
Paracoccygeal transsacral fixation is a novel percutaneous technique for arthrodesis of L5-S1 and L4-5 (Axial Lumbar Interbody Fusion [AxiaLIF]). There are no reports on feasible revision strategies. The goal of this paper is to analyze the surgical details of failed AxiaLIF constructs and to describe revision strategies.
The medical charts, operative records, and imaging studies of 5 patients with failed multisegment instrumentation using the AxiaLIF device were reviewed.
AxiaLIF constructs were revised in 5 patients with a mean age of 58.4 years. All AxiaLIF devices were part of multisegment fusion constructs for revision surgery and were revised an average of 15 months after implantation. Two AxiaLIF devices were percutaneously retrieved; one because of excessive bone resorption around the AxiaLIF screw, and the other because of chronic hardware infection. In these 2 patients, the anterior column was subsequently stabilized via anterior lumbar interbody fusion. In the other 3 patients, the AxiaLIF device was left in situ. In 2 of these patients the anterior column was stabilized with bilateral L5-S1 posterior lumbar interbody fusion, and in the remaining patient with L4-5 instability the posterior instrumentation only was revised. Revision surgeries were well tolerated. One patient suffered from a wound dehiscence of the back wound.
AxiaLIF devices are safely retrieved using percutaneous technique. Both anterior and posterior revision strategies may be used to achieve anterior column fixation.
经直肠尾骨固定术是一种用于 L5-S1 和 L4-5（轴向腰椎间融合术[AxiaLIF]）融合的新型经皮技术。目前尚无可行的翻修策略的报道。本文的目的是分析失败的 AxiaLIF 结构的手术细节，并描述翻修策略。
回顾了 5 例使用 AxiaLIF 装置进行多节段器械固定失败的患者的病历、手术记录和影像学研究。
5 例 AxiaLIF 结构的患者平均年龄为 58.4 岁。所有 AxiaLIF 器械均为多节段融合器械的一部分，用于翻修手术，在植入后平均 15 个月进行翻修。有 2 个 AxiaLIF 器械经皮取出；一个是因为 AxiaLIF 螺钉周围骨吸收过多，另一个是因为慢性硬件感染。在这 2 例患者中，随后通过前路腰椎间融合术稳定前柱。在另外 3 例患者中，AxiaLIF 器械仍留在原位。在这 2 例患者中，通过双侧 L5-S1 后路腰椎间融合术稳定前柱，在剩余 1 例 L4-5 不稳定的患者中仅对后路器械进行了翻修。翻修手术耐受良好。1 例患者背部伤口出现切口裂开。
AxiaLIF 器械可通过经皮技术安全取出。可采用前路和后路翻修策略来实现前柱固定。
