Revision surgical technique for laterally placed MinuteMan® interspinous devices using a novel VertiFix® removal system through a spinous process-preserving midline approach with InSpan fusion.

Abstract

The MinuteMan^® interspinous fixation device (IFD) is a titanium implant designed for percutaneous lateral placement to provide interspinous distraction and stabilization in the treatment of lumbar spinal stenosis and interspinous fusion when combined with bone graft. With increasing use by interventional pain management physicians, standardized techniques for revision of failed lateral interspinous implants are needed. Revision is technically challenging due to dense scar tissue formation and limited access to the implant, particularly when preservation of the spinous processes is required to allow reinstrumentation. To our knowledge, there are no prior reports describing removal of a laterally placed IFD with revision using a midline interlaminar IFD. We describe a spinous process-preserving open midline surgical technique using the VertiFix^® interspinous removal system for removal of a laterally placed IFD, followed by reinstrumentation with a midline interlaminar IFD (InSpan^®) to facilitate interspinous fusion. The technique involves circumferential scar tissue release, controlled implant removal, decompression, and revision implant placement. Patients demonstrated 60% and 70% reductions in pain at three months. Revision was associated with implant size increases from 8 to 14 mm and 16 mm, with restoration of interspinous height. Postoperative imaging confirmed stable implant positioning without complications. This two-case technical report describes a feasible posterior midline revision approach for selected failed laterally placed IFDs. The technique may allow controlled implant removal and interspinous reinstrumentation when the posterior elements remain suitable; however, larger studies with longer follow-up and radiographic fusion assessment are needed to evaluate reproducibility, fusion, durability, and long-term clinical outcomes.