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

Abstract

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.