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Context <p>Anterior Lumbar Interbody Fusion (ALIF) is used for degenerative spinal conditions, but reoperations are sometimes needed. Same-approach reoperation is challenging due to scarring and vascular proximity; literature on this is scarce.</p> Objective <p>To evaluate morbidity and clinical outcomes of same-approach ALIF reoperations by a specialized team.</p> Study design <p>Retrospective observational study.</p> Methods <p>Data from a prospectively maintained database (Instituto de Acesso à Coluna Aécio Dias) were analyzed for patients undergoing same-approach ALIF reoperation (cage exchange/removal) between April 2019 and June 2024 (<i>n</i> = 16). Inclusion criteria: age &gt; 18, prior ALIF, reoperation due to complications. Exclusion criteria: different approach, outside study period. Outcomes: intraoperative morbidity (vascular, organ, nerve injuries), postoperative morbidity (infections, VAS Scale, etc.), surgical strategies. Descriptive and inferential statistics (paired t-test, <i>p</i> &lt; 0.05) were used (Python).</p> Results <p>Mean age: 54.37 years (SD = 9.52); 62.5% male. Main reoperation indication: cage migration (43.75%). Mean interval between surgeries: 17.06 weeks (SD = 15.97). Three vascular injuries (1 arterial, 2 venous) occurred (18.75%). Two postoperative complications (retroperitoneal infection, lymphocele) were noted (12.5%). Mean operative time: 142.50&#xa0;min (SD = 56.50); mean blood loss: 114.06&#xa0;ml (SD = 64.52). Most reoperations were at L5-S1 (75%).</p> Conclusions <p>Same-approach ALIF reoperation appears safe with an experienced team. Higher lumbar level reoperations carry greater morbidity, warranting consideration of conservative management. Reoperation may be linked to initial procedural failures or patient selection. Risks are amplified compared to primary ALIF due to scar tissue.</p>

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Reoperations for cage removal or replacement in patients undergoing ALIF: operative morbidity and surgical strategy

  • 期刊论文

  • 发表日期：

    2025年6月10日

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  • Aécio Rubens Dias Pereira Filho,
  • Vinicius Santos Baptista,
  • Matheus Galvão Valadares Bertolini Mussalem,
  • Vinicius de Meldau Benites,
  • Milton Kiyonory Uehara,
  • Nuno Rodolfo Colaço Aguiar,
  • Alexandre Vinhal Desideri,
  • Allison Roxo Fernandes,
  • Francisco Cialdine Frota Carneiro Júnior

摘要

Context

Anterior Lumbar Interbody Fusion (ALIF) is used for degenerative spinal conditions, but reoperations are sometimes needed. Same-approach reoperation is challenging due to scarring and vascular proximity; literature on this is scarce.

Objective

To evaluate morbidity and clinical outcomes of same-approach ALIF reoperations by a specialized team.

Study design

Retrospective observational study.

Methods

Data from a prospectively maintained database (Instituto de Acesso à Coluna Aécio Dias) were analyzed for patients undergoing same-approach ALIF reoperation (cage exchange/removal) between April 2019 and June 2024 (n = 16). Inclusion criteria: age > 18, prior ALIF, reoperation due to complications. Exclusion criteria: different approach, outside study period. Outcomes: intraoperative morbidity (vascular, organ, nerve injuries), postoperative morbidity (infections, VAS Scale, etc.), surgical strategies. Descriptive and inferential statistics (paired t-test, p < 0.05) were used (Python).

Results

Mean age: 54.37 years (SD = 9.52); 62.5% male. Main reoperation indication: cage migration (43.75%). Mean interval between surgeries: 17.06 weeks (SD = 15.97). Three vascular injuries (1 arterial, 2 venous) occurred (18.75%). Two postoperative complications (retroperitoneal infection, lymphocele) were noted (12.5%). Mean operative time: 142.50 min (SD = 56.50); mean blood loss: 114.06 ml (SD = 64.52). Most reoperations were at L5-S1 (75%).

Conclusions

Same-approach ALIF reoperation appears safe with an experienced team. Higher lumbar level reoperations carry greater morbidity, warranting consideration of conservative management. Reoperation may be linked to initial procedural failures or patient selection. Risks are amplified compared to primary ALIF due to scar tissue.