Minimally Invasive Management of Complications from Previous Midline Spinal Surgery

Study background: The application of MIS techniques to address complications of previous midline surgery has not been fully explored. Methods: Three patients with previous midline lumbar surgery underwent revision surgery with minimally invasive approaches for management of either: infection, recurrent radiculopathy or symptomatic heterotopic bone formation. Results: Patient 1 was found to have a persistent discitis 10 months after a lumbar fusion that was complicated by a pseudoarthrosis and infection requiring a second surgery for additional stabilization and third surgery for an incision and drainage. To avoid reopening the incision for a fourth time, a minimally invasive retractor was used to access the disc space and remove the interbody spacer. Patient 2 experienced a recurrent radiculopathy three months after an L5-S1 transforaminal lumbar interbody fusion. CT scan demonstrated heterotopic bone formation into the S1 neural foramen. A minimally invasive retractor was used through a paramedian incision to explant the pedicle screw rod construct on the symptomatic side, remove the heterotopic bone formation and decompress the neural foramen. Patient 3 experienced onset of an S1 radiculopathy 11 years after an L4 to S1 fusion. A fixed tubular minimally invasive retractor was used to access the S1 neural foramen and decompress the symptomatic root. Conclusions: Minimally invasive spinal surgical techniques have the capacity to adequately address focal complications that have occurred with midline surgery. These techniques preclude the need to reopen a previous incision, which is especially valuable in those patients with delayed healing capacity, extensive previous surgery or previous infection. *Corresponding author: Luis M. Tumialán, Division of Neurological Surgery, c/o Neuroscience Publications; Barrow Neurological Institute St. Joseph’s Hospital and Medical Center 350 W. Thomas Road; Phoenix, AZ 85013, USA; Tel: (602) 406.3593; Fax: (602) 406.4104; E-mail: [email protected] Received November 04, 2013; Accepted November 12, 2013; Published November 16, 2013 Citation: Tumialán LM, Mahan MA, Marciano FF, Theodore N (2013) Minimally Invasive Management of Complications from Previous Midline Spinal Surgery. J Spine S5: 007. doi:10.4172/2165-7939.S5-007 Copyright: © 2013 Tumialán LM, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.