Revision surgery of lumbar interbody fusion with cage
- VernacularTitle:腰椎椎间融合器的翻修手术
- Author:
Shaodong ZHANG
;
Tiansi TANG
;
Xiaotao WU
- Publication Type:Journal Article
- Keywords:
Lumbar vertebrae;
Spinal fusion;
Postoperative complications;
Reoperation
- From:
Chinese Journal of Orthopaedics
1996;0(09):-
- CountryChina
- Language:Chinese
-
Abstract:
Objective To evaluate the methods and results of revision surgery for posterior lumbar cage interbody fusion (cage-PLIF) with postoperative complications, and to analyse the surgical techniques for prevention of these complications. Methods From October 1996 to December 2002, 21 patients with postoperative complications of cage-PLIF underwent reoperations. There were 11 males and 10 females with an average of 43.4 years. The interval between primary and revision surgery ranged from 6 days to 1.5 years with an average of 0.6 year. 16 patients suffering from lumbar disc herniation were treated with the discecto-my and single uninstrumented cage fusion, 5 patients of lumbar spondylolisthesis were treated with cage-PLIF and pedicle screw instrumentation. The complications included cage displacement backward in 20 patients, forward in 1,and cage subsidence in 9 as well. 15 patients complained of low back pain wors-ening or leg radicular pain, of which 4 had intermittent claudication and 10 had leg numbness or weakness during rehabilitation. Revision surgery included re-implantation of the cage filled with iliac crest bone chips in 11 patients, iliac bone autograft after removal of original cages in 7 and decompression of involved nerve root witbout removal of migrated cage because of technical difficulty. Pedicle screw fixations were used in 12 and the intertransverse fusion both with autograft and allograft was added in 7. Results The mean follow-up was 14.2 months (ranged, 7 to 36 months). The cages presented slight retro-displacement in 4 patients shortly after reoperation, without involvement into spinal canal during the subsequent follow-up. Bony fusion occurred in 13 patients, and the pseudarthrosis in 3 patients without further migration of cages. The clinical symptoms relieved in 5 patients, improved in 9, no any change in 6, and worsened in 1. However, low back pain remained in 8 patients, and dysuria in 1 patiant at the last follow-up. Conclusion The results of revi-sion surgery are not satisfactory according to this study, the surgical treatments should be performed as soon as possible if conservative treatments is ineffective. The correct surgical indication and proper technical are the key of prevention of the postoperative complications.
