Risks with Anterior Revision Procedures

In this study, surgeons report on the risks of having implants called cages removed from the spine. Fourteen (14) patients with spinal fusion were included.

Original devices used to support the spine were put in anteriorly (from the front), posteriorly (from the back), or transforaminal (from the side at an angle). All implants were taken out anteriorly. Bone graft was used to fuse the spine after hardware removal.

The reasons for revision surgery included pseudoarthrosis, movement of the cage, and infection. Pseudoarthrosis means false joint. There is movement where there shouldn't be.

One patient had nerve compression from the hardware (a screw) pressing on it. More than half of the patients had cage removal from the L45 level. The rest were from L5S1.

The authors report lumbar interbody revisions are complicated operations. A laceration or cut of the blood vessels is the biggest problem. In this group of patients, 71 percent had major problems. More than half were from vascular injuries.

This is the first study published to report complication rate with revision surgery after lumbar fusion with interbody devices. Scar tissue from the first operation increased the risk of blood vessel damage during revision surgery. Surgeons are advised to find and control the blood vessel above and below the operative site to avoid vascular complications during revision procedures.

Reference: 

Hoan-Vu Nguygen, MD, et al. Anterior Exposure of the Spine for Removal of Lumbar Interbody Devices and Implants. In Spine. October 1, 2006. Vol. 31. No. 21. Pp. 2449-2453.

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