title: Minimally invasive presacral retrieval of a failed AxiaLIF rod implant: technical note and illustrative cases.
abstract: BACKGROUND
  There are few reported cases of failed axial lumbar interbody fusion (AxiaLIF) in the existing neurosurgical literature, and an anecdotal case of open paramedian retroperitoneal approach to L5-S1 level for retrieval of AxiaLIF rod has been published.
  
  
  OBJECTIVE
  The object of this study is to illustrate a minimally invasive presacral rod retrieval technique in cases with failed AxiaLIF causing lumbosacral instability.
  
  
  METHODS
  Retrospective case series.
  
  
  METHODS
  A retrospective analysis of the initial 26 cases of AxiaLIF done at our institution was performed; two cases of failed AxiaLIF that required rod removal were identified for detailed study. Available literature on the minimally invasive presacral techniques for rod retrieval was researched, and the use of a novel rod retrieval device with an expanding hex tip is discussed.
  
  
  RESULTS
  Using a minimally invasive presacral approach through the previous surgical corridor, the authors were able to retrieve the AxiaLIF rod implant and then proceed with an alternative fusion technique. Both patients improved clinically and radiographically after revision. Removal of the presacral rod was not associated with vascular or bowel complications and required minimal operating room time with minimal blood loss.
  
  
  CONCLUSIONS
  To the authors' knowledge, this is the first report demonstrating the safety and efficacy of minimally invasive presacral approach for removal of AxiaLIF rods in patients with failed AxiaLIF. As the AxiaLIF procedure is rapidly gaining acceptance among spine surgeons, we can expect to see increasing numbers of failed procedures as well. Understanding options for revision strategies is important for surgeons considering the use of this technique.
authors.affiliation: Department of Neurological Surgery, The Neurological Institute, University Hospitals Case Medical Center, 11100 Euclid Ave., HAN 5042, Cleveland, OH 44106, USA.
authors.forename: Sunil
authors.initials: S
authors.lastname: Manjila
authors.forename: Justin
authors.initials: J
authors.lastname: Singer
authors.forename: Kathleen
authors.initials: K
authors.lastname: Knudson
authors.forename: Andreas C
authors.initials: AC
authors.lastname: Tomac
authors.forename: David J
authors.initials: DJ
authors.lastname: Hart
mesh_terms: D000328:Adult; D001863:Bone Screws / Q000009:adverse effects*; D020878:Device Removal / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D011183:Postoperative Complications / Q000209:etiology / Q000601:surgery; D011475:Prosthesis Failure; D012189:Retrospective Studies; D012447:Sacrum / Q000601:surgery; D013123:Spinal Fusion / Q000009:adverse effects*; D016896:Treatment Outcome