Hi
I've considered the issues surrounding re-entry following a previous anterior approach for some time.
I don't personally need to remove one of my ADR's but I am considering fusion of my L4/5 which is currently sandwiched between 2 supposedly functioning ADR's at L3/4 and L5/S1. Because of a previous extensive posterior decompression surgery in 1988 I am keen to avoid another posterior surgery for fear of scar tissue forming around the nerve roots which necessarily need to be moved for a posterior access. I know the risks of a repeat anterior are potentially even more frightening for reasons concerning scar tissue and the major blood vessels.
Some time ago a fusion via a lateral transpsoas approach was suggested to me - in theory this avoids the risks to both the major blood vessels and nerve root damage. My research has subsequently led to an approach known as the XLIF - Extreme Lateral interbody Fusion. This sounds very similar if not identical to the approch suggested for me.
Recently I came across an article outlining the details of two cases of ADR device revision in which they used a minimally invasive extreme-lateral interbody approach to effect a safer access route, avoiding vascular structures and the creation of scar tissue. I thought those facing revision surgery might find this interesting - unfortunately the link is to a html version which lacks images but it is still understandable..
The link is as follows:
http://66.102.9.104/search?q=cache:O...nk&cd=12&gl=uk
I hope this works... if not let me know and I'll copy and paste the text.
You can read more about the XLIF technique regards fusion at the following links:
1.
http://sutterroseville.org/news/pres...release_id=569
2.
http://lajollaspine.com/stmi_lumb_xlif.shtml
3.
http://www.floridahospitalmedicalnew...lth-id242.html
4.
http://illinoisneurospine.com/_wsn/page11.html
5.
http://www.devicelink.com/mddi/archive/04/10/012.html
If anybody has personal experience with this technique and/or if anybody knows any surgeons in the UK using this technique I'd love to hear from you.
Blair - I wish you good luck in you upcoming revision surgery.
All the best
Tim