Oblique Lumbar Interbody Fusion for Revision of Non‐union Following Prior Posterior Surgery: A Case Report

摘要

We report the case of a 75‐year‐old lady who presented with a L 2‐3 non‐union 18 months following a L 2‐3 and L 3‐4 posterior decompression and transforaminal lumbar interbody fusion. Halo of the L 2 pedicle screws on imaging was consistent with a non‐union at the L 2‐3 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 L 2‐3 level using an oblique technique. This involved dissection anterior to the psoas muscle to access the L 2‐3 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 L 2,3 level. The OLIF technique is feasible for revision of a non‐union of upper lumbar levels, with satisfactory fusion achieved with acceptable feasibility.