Restoring segmental lumbar lordosis after failed previous fusion at the same level.

Abstract

One of the major challenges in revision spinal surgery lies in restoring segmental lordosis at the level of previous surgery. We have developed a surgical technique that can help to avoid the need for a long surgical procedure, reduce the extent of spinal instrumentation, and eliminate the need for multiple stages of surgery in order to significantly restore lumbar lordosis after a failed previous operation. In this article, we provide our single institutional surgical experience including main indications and contraindications, a step-by-step surgical technique description. Segmental lordosis is restored by enhancing mobility of the lumbar segment. The main step involves total dissection of the annulus fibrosus via a posterior approach under C-arm fluoroscopy. Segmental lordosis is restored using an intervertebral cage placed in the anterior third of the intervertebral space, an operating table set in a head-up feet-up position, and segmental contraction achieved by moving screw heads closer to each other on the rods. We discuss possible complications that may arise from using our technique, including laceration of the retroperitoneal vessels and anterior cage migration following anterior longitudinal ligament release. Finally, we summarize our research experience in this surgical technique. Our institutional experience shows that the restoration of segmental lordosis via a posterior approach is a highly efficient and safe surgical procedure, especially when there is a failed previous fusion at the same level. A surgical instructional video accompanies this article.