Axial Lumber Interbody Fusion as an Alternative "Salvage" Approach to Lumbosacral Fixation: A Case Series.

IF 1.7 Q2 SURGERY
Paul D Korytkowski, John Panzone, Sean J Cannizzaro, William F Lavelle, Richard A Tallarico
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引用次数: 0

Abstract

Background: Lumbar interbody fusion is commonly performed to improve spinal stability in the context of degenerative, traumatic, and deformity-related pathologies. The axial lumbar interbody fusion (AxiaLIF) technique, also known as presacral interbody arthrodesis, is the only presacral interbody fusion technique approved by the US Food and Drug Administration. It is a rarely utilized approach to interbody fusion that aims to achieve fusion across L4 to L5 and/or L5 to S1 levels, which are the most susceptible to pseudoarthrosis and hardware failure. This case series describes the utility of the AxiaLIF procedure as a salvage approach when traditional interbody fusion techniques pose significant risks or are not feasible due to rare patient-specific factors.

Methods: All identifiable cases of the AxiaLIF procedure performed at a single, academic medical center were reviewed. Operative data were collected and each case presentation is described in detail.

Results: Six patients underwent AxiaLIF between July 2010 and May 2022. Indications for AxiaLIF as a salvage approach included hardware failure with a significant risk of recurrence with traditional revision techniques; a lack of segmental fixation at the distal end of the spinal construct; avoiding extensive tissue disruption in the setting of staged realignment surgery or previously compromised tissue; and comorbidities such as muscular dystrophy, abdominal hernias, and severe obesity. Two patients were fused solely across the L5 to S1 level, and 4 patients were fused from L4 to S1. The mean operative time, estimated blood loss, time under fluoroscopy, complications, and follow-up were noted.

Conclusion: This case series introduces the utility of AxiaLIF as a salvage approach. We believe the AxiaLIF procedure may be a valuable alternative to traditional lumbar interbody fusion in salvage situations when traditional techniques are not feasible or pose significant risk to the patient. In such situations, surgeon awareness of this approach has the potential to improve patient outcomes and safety.

Clinical relevance: AxiaLIF, as a salvage approach, has the potential to improve patient outcomes safely when other surgical options pose significant risk or are not feasible.

Level of evidence: 4:

轴向腰椎椎间融合术作为另一种“打捞”方法用于腰骶固定:一个病例系列。
背景:腰椎椎体间融合术通常用于改善退行性、创伤性和畸形相关病理的脊柱稳定性。轴向腰椎椎间融合术(axial椎间融合术),也称为骶前椎间融合术,是唯一获得美国食品和药物管理局批准的骶前椎间融合术。这是一种很少使用的椎间融合方法,旨在实现L4至L5和/或L5至S1节段的融合,这两个节段最容易发生假关节和硬件故障。本病例系列描述了当传统椎体间融合技术存在重大风险或由于罕见的患者特异性因素而不可行的情况下,AxiaLIF手术作为一种挽救方法的效用。方法:对在单一学术医疗中心进行的所有可识别的AxiaLIF手术病例进行回顾。收集了手术资料,并详细描述了每个病例的表现。结果:2010年7月至2022年5月期间,6例患者接受了AxiaLIF治疗。AxiaLIF作为挽救入路的适应症包括传统翻修技术有复发风险的硬件故障;脊柱结构远端缺乏节段性固定;避免在分阶段复位手术或先前受损的组织设置广泛的组织破坏;以及肌肉萎缩症、腹疝和严重肥胖等合并症。2例患者仅在L5至S1段融合,4例患者从L4至S1段融合。记录平均手术时间、估计失血量、透视时间、并发症和随访情况。结论:本案例系列介绍了AxiaLIF作为抢救方法的实用性。我们认为,当传统技术不可行或对患者构成重大风险时,AxiaLIF手术可能是传统腰椎椎体间融合术的一种有价值的替代方案。在这种情况下,外科医生意识到这种方法有可能改善患者的预后和安全性。临床意义:当其他手术方案存在重大风险或不可行时,作为一种挽救方法,AxiaLIF有可能安全地改善患者的预后。证据等级:4;
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
3.10
自引率
0.00%
发文量
162
期刊介绍: The International Journal of Spine Surgery is the official scientific journal of ISASS, the International Intradiscal Therapy Society, the Pittsburgh Spine Summit, and the Büttner-Janz Spinefoundation, and is an official partner of the Southern Neurosurgical Society. The goal of the International Journal of Spine Surgery is to promote and disseminate online the most up-to-date scientific and clinical research into innovations in motion preservation and new spinal surgery technology, including basic science, biologics, and tissue engineering. The Journal is dedicated to educating spine surgeons worldwide by reporting on the scientific basis, indications, surgical techniques, complications, outcomes, and follow-up data for promising spinal procedures.
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