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Novel Use of Bilateral Prone Transpsoas Approach for the Treatment of Transforaminal Interbody Fusion Pseudarthrosis and Interbody Cage Subsidence – Lumbar Fusion

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The article discusses a novel technique for treating pseudarthrosis, a complication that occurs after transforaminal lumbar interbody fusion (TLIF). Pseudarthrosis can lead to recurrent symptoms and the need for revision surgery. The article describes a bilateral prone transpsoas (PTP) approach to remove a subsided TLIF cage and replace it with a new lateral cage. The article also proposes an approach algorithm for TLIF cage removal based on the experience of the surgeons. The results of the technique showed retractor time of less than 10 minutes on each side and resolution of the patient’s symptoms postoperatively. The article concludes that the bilateral PTP retractors can be effective in cases of pseudarthrosis with severe cage subsidence, but careful consideration of various factors is necessary to determine the appropriate treatment for each case

Summarised by Mr Mo Akmal – Lead Spinal Surgeon
The London Spine Unit : most established day surgery hospital in UK

Published article

: Bilateral PTP retractors for TLIF cage removal may be effectively used in cases of pseudarthrosis with severe cage subsidence. Careful consideration of various factors, including patient surgical history, body habitus, and intraoperative findings, is essential in determining the appropriate treatment for these complex cases.

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Oper Neurosurg (Hagerstown). 2024 Feb 2. doi: 10.1227/ons.0000000000001057. Online ahead of print.ABSTRACTBACKGROUND AND OBJECTIVES: Pseudarthrosis is a complication after transforaminal lumbar interbody fusion (TLIF) that leads to recurrent symptoms and potential revision surgery. Subsidence of the interbody adds to the complexity of surgical revision. In addition, we report a novel technique for the treatment of,

Oper Neurosurg (Hagerstown). 2024 Feb 2. doi: 10.1227/ons.0000000000001057. Online ahead of print.

ABSTRACT

BACKGROUND AND OBJECTIVES: Pseudarthrosis is a complication after transforaminal lumbar interbody fusion (TLIF) that leads to recurrent symptoms and potential revision surgery. Subsidence of the interbody adds to the complexity of surgical revision. In addition, we report a novel technique for the treatment of TLIF pseudarthrosis with subsidence and propose an approach algorithm for TLIF cage removal.

METHODS: Cases of reoperation for TLIF pseudarthrosis were reviewed. We report a novel technique using a bilateral prone transpsoas (PTP) approach to remove a subsided TLIF cage and place a new lateral cage. An approach algorithm was developed based on the experience of TLIF cage removal. The patient was placed in the prone position with somatosensory evoked potential and electromyography monitoring. A PTP retractor was placed using standard techniques on the ipsilateral side of the previous TLIF. After the discectomy, the subsided TLIF cage was visualized but unable to be removed. The initial dilator was closed, and a second PTP retractor was placed on the contralateral side. After annulotomy and discectomy to circumferentially isolate the subsided cage, a box cutter was used to push and mobilize the TLIF cage from this contralateral side, which could then be pulled out from the ipsilateral side. A standard lateral interbody cage was then placed.

RESULTS: Retractor time was less than 10 minutes on each side. The patient’s symptoms resolved postoperatively. We review illustrative cases of various approaches for TLIF cage removal spanning the lumbosacral spine and recommend an operative approach based on the lumbar level, degree of subsidence, and mobility of the interbody.

: Bilateral PTP retractors for TLIF cage removal may be effectively used in cases of pseudarthrosis with severe cage subsidence. Careful consideration of various factors, including patient surgical history, body habitus, and intraoperative findings, is essential in determining the appropriate treatment for these complex cases.

PMID:38305422 | DOI:10.1227/ons.0000000000001057

The London Spine Unit : most established day surgery hospital in UK

Read the original publication:

Novel Use of Bilateral Prone Transpsoas Approach for the Treatment of Transforaminal Interbody Fusion Pseudarthrosis and Interbody Cage Subsidence

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Oper Neurosurg (Hagerstown). 2024 Feb 2. doi: 10.1227/ons.0000000000001057. Online ahead of print.ABSTRACTBACKGROUND AND OBJECTIVES: Pseudarthrosis is a complication after transforaminal lumbar interbody fusion (TLIF) that leads to recurrent symptoms and potential revision surgery. Subsidence of the interbody adds to the complexity of surgical revision. In addition, we report a novel technique for the treatment of

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