Awake, Endoscopic Revision Surgery for Lumbar Pseudarthrosis after TLIF: Technical Note.

January 21, 2020

OBJECTIVE:

To evaluate the feasibility for awake, endoscopic treatment of lumbar pseudarthrosis after a transforaminal lumbar interbody fusion (TLIF).

METHODS:

A 71-year-old male with severe cardiac disease, determined to be high risk for general anesthesia, presented with mechanical back pain and a L3-4 pseudarthrosis and L3 pedicle screw loosening after a L3-5 transforaminal lumbar interbody fusion (TLIF). An awake, transforaminal endoscopic redo discectomy and TLIF procedure was performed by removing residual disc material adjacent to the previous PEEK interbody spacer and placing allograft, bone morphogenetic protein (BMP) and an expandable titanium interbody device adjacent to the PEEK cage.

RESULTS:

At one year follow up preoperative visual analog scale (VAS) for back pain and Oswestry disability index (ODI) improved from 7 and 38% to 1 and 2%. One year follow up x-ray showed stable interbody placement and no further screw loosening.