{"title":"ALIF患者再手术取出或置换笼：手术发病率和手术策略。","authors":"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","doi":"10.1007/s10143-025-03670-3","DOIUrl":null,"url":null,"abstract":"<p><strong>Context: </strong>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><p><strong>Objective: </strong>To evaluate morbidity and clinical outcomes of same-approach ALIF reoperations by a specialized team.</p><p><strong>Study design: </strong>Retrospective observational study.</p><p><strong>Methods: </strong>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).</p><p><strong>Inclusion criteria: </strong>age > 18, prior ALIF, reoperation due to complications.</p><p><strong>Exclusion criteria: </strong>different approach, outside study period.</p><p><strong>Outcomes: </strong>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).</p><p><strong>Results: </strong>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%).</p><p><strong>Conclusions: </strong>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>","PeriodicalId":19184,"journal":{"name":"Neurosurgical Review","volume":"48 1","pages":"499"},"PeriodicalIF":2.5000,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Reoperations for cage removal or replacement in patients undergoing ALIF: operative morbidity and surgical strategy.\",\"authors\":\"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\",\"doi\":\"10.1007/s10143-025-03670-3\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Context: </strong>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><p><strong>Objective: </strong>To evaluate morbidity and clinical outcomes of same-approach ALIF reoperations by a specialized team.</p><p><strong>Study design: </strong>Retrospective observational study.</p><p><strong>Methods: </strong>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).</p><p><strong>Inclusion criteria: </strong>age > 18, prior ALIF, reoperation due to complications.</p><p><strong>Exclusion criteria: </strong>different approach, outside study period.</p><p><strong>Outcomes: </strong>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).</p><p><strong>Results: </strong>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%).</p><p><strong>Conclusions: </strong>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>\",\"PeriodicalId\":19184,\"journal\":{\"name\":\"Neurosurgical Review\",\"volume\":\"48 1\",\"pages\":\"499\"},\"PeriodicalIF\":2.5000,\"publicationDate\":\"2025-06-10\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Neurosurgical Review\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1007/s10143-025-03670-3\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"CLINICAL NEUROLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Neurosurgical Review","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1007/s10143-025-03670-3","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
引用次数: 0
摘要
背景：前路腰椎椎体间融合术（ALIF）用于脊柱退行性疾病，但有时需要再次手术。由于疤痕和血管邻近，同一入路的再手术具有挑战性；这方面的文献很少。目的：评价专科小组同入路ALIF再手术的发病率和临床效果。研究设计：回顾性观察性研究。方法：对2019年4月至2024年6月期间接受同一入路ALIF再手术（笼置换/取出）的患者（n = 16）的前瞻性数据库（Instituto de Acesso Coluna aacimcio Dias）的数据进行分析。纳入标准：年龄bb ~ 18岁，既往ALIF，因并发症再手术。排除标准：不同方法，研究期外。结果：术中发病率（血管、器官、神经损伤），术后发病率（感染、VAS评分等），手术策略。描述性和推断性统计（配对t检验，p）结果：平均年龄54.37岁（SD = 9.52）；62.5%的男性。再手术主要指征：笼内移位（43.75%）。平均手术间隔：17.06周（SD = 15.97）。血管损伤3例（动脉损伤1例，静脉损伤2例）（18.75%）。术后出现2例并发症（腹膜后感染、淋巴囊肿）（12.5%）。平均手术时间：142.50 min (SD = 56.50)；平均失血量：114.06 ml （SD = 64.52）。大多数再手术发生在L5-S1（75%）。结论：同入路ALIF再手术在经验丰富的团队中是安全的。较高腰椎段再手术的发病率较高，需要考虑保守治疗。再手术可能与最初的手术失败或患者选择有关。由于瘢痕组织，与原发性ALIF相比，风险更大。
Reoperations for cage removal or replacement in patients undergoing ALIF: operative morbidity and surgical strategy.
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.
期刊介绍：
The goal of Neurosurgical Review is to provide a forum for comprehensive reviews on current issues in neurosurgery. Each issue contains up to three reviews, reflecting all important aspects of one topic (a disease or a surgical approach). Comments by a panel of experts within the same issue complete the topic. By providing comprehensive coverage of one topic per issue, Neurosurgical Review combines the topicality of professional journals with the indepth treatment of a monograph. Original papers of high quality are also welcome.
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