Department of Neurological Surgery, The Neurological Institute, University Hospitals Case Medical Center, 11100 Euclid Ave., HAN 5042, Cleveland, OH 44106, USA.
Spine J. 2012 Oct;12(10):940-8. doi: 10.1016/j.spinee.2012.10.026.
There are few reported cases of failed axial lumbar interbody fusion (AxiaLIF) in the existing neurosurgical literature, and an anecdotal case of open paramedian retroperitoneal approach to L5-S1 level for retrieval of AxiaLIF rod has been published.
The object of this study is to illustrate a minimally invasive presacral rod retrieval technique in cases with failed AxiaLIF causing lumbosacral instability.
STUDY DESIGN/SETTING: Retrospective case series.
A retrospective analysis of the initial 26 cases of AxiaLIF done at our institution was performed; two cases of failed AxiaLIF that required rod removal were identified for detailed study. Available literature on the minimally invasive presacral techniques for rod retrieval was researched, and the use of a novel rod retrieval device with an expanding hex tip is discussed.
Using a minimally invasive presacral approach through the previous surgical corridor, the authors were able to retrieve the AxiaLIF rod implant and then proceed with an alternative fusion technique. Both patients improved clinically and radiographically after revision. Removal of the presacral rod was not associated with vascular or bowel complications and required minimal operating room time with minimal blood loss.
To the authors' knowledge, this is the first report demonstrating the safety and efficacy of minimally invasive presacral approach for removal of AxiaLIF rods in patients with failed AxiaLIF. As the AxiaLIF procedure is rapidly gaining acceptance among spine surgeons, we can expect to see increasing numbers of failed procedures as well. Understanding options for revision strategies is important for surgeons considering the use of this technique.
在现有的神经外科学文献中，很少有报道轴向腰椎椎间融合术（AxiaLIF）失败的病例，并且已经发表了一则关于开放旁正中腹膜后入路以检索 L5-S1 水平 AxiaLIF 杆的轶事案例。
本研究的目的是展示一种微创经骶前杆检索技术，适用于 AxiaLIF 失败导致腰骶部不稳定的病例。
研究设计/设置：回顾性病例系列。
对我院进行的最初 26 例 AxiaLIF 病例进行回顾性分析；确定了 2 例需要去除杆的 AxiaLIF 失败病例进行详细研究。对微创经骶前技术用于检索杆的现有文献进行研究，并讨论了使用具有扩展六角尖端的新型杆检索装置的情况。
通过先前的手术通道，使用微创经骶前方法，作者能够检索 AxiaLIF 杆植入物，然后进行替代融合技术。两位患者在翻修后临床和影像学均有改善。经骶前杆的移除与血管或肠道并发症无关，需要最少的手术室时间和最小的出血量。
据作者所知，这是首例报道证明微创经骶前方法用于移除 AxiaLIF 杆在 AxiaLIF 失败患者中的安全性和有效性。随着 AxiaLIF 手术在脊柱外科医生中迅速获得认可，我们预计也会看到越来越多的失败手术。对于考虑使用这种技术的外科医生来说，了解修订策略的选择很重要。
