脊椎ジャーナル

Minimally Invasive Management of Complications from Previous Midline Spinal Surgery

Abstract

Luis M Tumialán, Mark A Mahan, Frederick F. Marciano and Nicholas Theodore

Study background: The application of MIS techniques to address complications of previous midline surgery has not been fully explored.

Methods: Three patients with previous midline lumbar surgery underwent revision surgery with minimally invasive approaches for management of either: infection, recurrent radiculopathyor symptomatic heterotopic bone formation.

Results: Patient 1 was found to have a persistent discitis 10 months after a lumbar fusion that was complicated by a pseudoarthrosis and infection requiring a second surgery for additional stabilization and third surgery for an incision and drainage. To avoid reopening the incision for a fourth time, a minimally invasive retractor was used to access the disc space and remove the interbody spacer. Patient 2 experienced a recurrent radiculopathy three months after an L5-S1 transforaminal lumbar interbody fusion. CT scan demonstrated heterotopic bone formation into the S1 neural foramen. A minimally invasive retractor was used through a paramedian incision to explant the pedicle screw rod construct on the symptomatic side, remove the heterotopic bone formation and decompress the neural foramen. Patient 3 experienced onset of an S1 radiculopathy 11 years after an L4 to S1 fusion. A fixed tubular minimally invasive retractor was used to access the S1 neural foramen and decompress the symptomatic root.

Conclusions: Minimally invasive spinal surgical techniques have the capacity to adequately address focal complications that have occurred with midline surgery. These techniques preclude the need to reopen a previous incision, which is especially valuable in those patients with delayed healing capacity, extensive previous surgery or previous infection.