Access strategies for revision or explantation of the Charite lumbar ADR

[Tim]

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

[mmglobal]

Tim, I've seen Nuvasiv's MaXcess system demonstrated at a surgeon's conference... very impressive access created. It will be interesting to see if retrieval of a keeled device through an extreme or translateral procedure will be or has already been successful. Again, as these aproaches are tried and succeed... a handful of cases done by other surgeons does not make it a slam dunk for others. If you need revision surgery, you are in rare air.

Mark

[grima6]

Hi Mark

I was happily polishing the same table for the fifth time (as diversional therapy) teying not to think about my revision surgery in 11 days AND THEN..... I READ YOUR POST! Now I am pretty worried. Even though the info was great in explaining the ins and outs of revision surgery, the fact that I am one of the really problematic maverick keeled discs you talked about has got me shaking in my boots!!!! As an RN I know that there are Vascular risks with L5-S1 revision surgery but now I am more aware of why Australian Drs didn't want to take out my keeled disc. The Maverick comes with the largest keel. Lucky me!!
Oh Well gotta look on the bright side, any change is good and as many of ISPINE people know the biggest fear when going in for surgery is not paralysis it is NO CHANGE, then the same crap just keeps going on with no light at the end of the tunnel.

Keep your fingers crossed for me Mark, I may just be a great Maverick revision test-case afterall!

[acheybreaky]

Man oh man, am I glad I found this site. Thanks Dr. J for posting this study. I originally found this on another forum, but it disappeared. Unfortunately for me, I am needing redo surgery and this topic is very close to my heart. Thanks Mark for providing such excellent information. It looks like I've come to the right place, you'll be hearing from me soon. Wow, I'm the 4th one here considering an ADR redo. I think that the outcomes for ADR are pretty good. We are the unlucky ones. I've been reading the forums a long time, but never post. I'm going back to lurk mode, but I just wanted to say thanks to Dr. J, Mark and everyone else that contributes. Sometimes I feel like I don't know enough and never feel like I have anything important to say.

abHeart

[Blairsara]

AcheyBreaky,
What kind of artificial disc do you have? My revision surgery is scheduled for May 24th and I have charite. I hope you're not in as much of pain as I am. Hope you're doing well. Why are you considering doing a revision? Do you have problems with your facet joints? Was it the placement?

Blair

[Maria]

Dr J and Mark,
Thanks for the information re revision surgery. Keep posting more please..