Christoph P Hofstetter1, Andrew R James, Roger Härtl. 1. Department of Neurological Surgery and Weill Cornell Medical College, New York-Presbyterian Hospital, New York, New York 10065, USA.
Abstract
OBJECT: 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. METHODS: The medical charts, operative records, and imaging studies of 5 patients with failed multisegment instrumentation using the AxiaLIF device were reviewed. RESULTS: 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. CONCLUSIONS: AxiaLIF devices are safely retrieved using percutaneous technique. Both anterior and posterior revision strategies may be used to achieve anterior column fixation.
OBJECT: 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. METHODS: The medical charts, operative records, and imaging studies of 5 patients with failed multisegment instrumentation using the AxiaLIF device were reviewed. RESULTS: 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. CONCLUSIONS: AxiaLIF devices are safely retrieved using percutaneous technique. Both anterior and posterior revision strategies may be used to achieve anterior column fixation.