title: Oblique Lumbar Interbody Fusion for Revision of Non-union Following Prior Posterior Surgery: A Case Report.
abstract: We report the case of a 75-year-old lady who presented with a L2-3 non-union 18 months following a L2-3 and L3-4 posterior decompression and transforaminal lumbar interbody fusion. Halo of the L2 pedicle screws on imaging was consistent with a non-union at the L2-3 level. An anterior lumbar interbody fusion (ALIF) approach was originally considered. However, due to the high lumbar approach and patient habitus [body mass index (BMI) > 35], a decision was made to approach the L2-3 level using an oblique technique. This involved dissection anterior to the psoas muscle to access the L2-3 disc space. The psoas, kidney and retroperitoneum were retracted using a Synframe for the oblique trajectory. Removal of the prior trans-foraminal lumbar interbody fusion cage was performed via the oblique approach and insertion of a revised implant. The operation was completed successfully with no perioperative complications noted. Length of stay was 3 days, with the patient achieving rapid pain relief. In the present report, we report the first case using an oblique lumbar interbody fusion (OLIF) approach for revision of a prior posterior fusion non-union at the L2,3 level. The OLIF technique is feasible for revision of a non-union of upper lumbar levels, with satisfactory fusion achieved with acceptable feasibility.
authors.affiliation: NeuroSpine Surgery Research Group, Sydney, New South Wales, Australia.|NeuroSpine Clinic, Prince of Wales Private Hospital, Sydney, New South Wales, Australia.|University of New South Wales, Sydney, New South Wales, Australia.
authors.forename: Kevin
authors.initials: K
authors.lastname: Phan
authors.affiliation: NeuroSpine Surgery Research Group, Sydney, New South Wales, Australia.|NeuroSpine Clinic, Prince of Wales Private Hospital, Sydney, New South Wales, Australia.|University of New South Wales, Sydney, New South Wales, Australia.
authors.forename: Ralph J
authors.initials: RJ
authors.lastname: Mobbs
mesh_terms: D000368:Aged; D019299:Decompression, Surgical / Q000379:methods; D005260:Female; D006801:Humans; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery*; D012086:Reoperation / Q000379:methods; D013123:Spinal Fusion / Q000379:methods*; D013130:Spinal Stenosis / Q000601:surgery; D013168:Spondylolisthesis / Q000601:surgery; D014057:Tomography, X-Ray Computed
keywords: Non‐union; Oblique lumbar interbody fusion; Pseudoarthrosis