PT  - JOURNAL ARTICLE
AU  - Dias Pereira Filho, Aécio Rubens
AU  - Bertolini Mussalem, Matheus Galvão Valadares
AU  - Baptista, Vinicius Santos
AU  - Benites, Vinicius de Meldau
AU  - Uehara, Milton Kiyonory
AU  - Colaço Aguiar, Nuno Rodolfo
AU  - Baston, Arthur Cristiano
AU  - Desideri, Alexandre Vinhal
AU  - Frota Carneiro Júnior, Francisco Cialdine
TI  - Safety and Viability of Anterior Lumbar Interbody Fusion in Complex Revision Lumbar Spine Surgeries: Insights From a Case Series of 135 Patients on Transforaminal Lumbar Interbody Fusion/Posterior Lumbar Interbody Fusion Cage Removal
AID  - 10.14444/8753
DP  - 2025 Apr 17
TA  - International Journal of Spine Surgery
PG  - 8753
4099  - https://www.ijssurgery.com/content/early/2025/04/17/8753.short
4100  - https://www.ijssurgery.com/content/early/2025/04/17/8753.full
AB  - Background Anterior lumbar interbody fusion (ALIF) has emerged as a valuable technique for managing lumbar degenerative conditions and revision surgeries, particularly for addressing complications associated with transforaminal lumbar interbody fusion (TLIF) and posterior lumbar interbody fusion (PLIF) cages. However, there is limited evidence documenting its safety and feasibility in the context of revision procedures involving cage removal.Objective To evaluate intraoperative outcomes of ALIF for TLIF/PLIF cage removal, focusing on complications, surgical times, and blood loss in a substantial case series.Methods This case series analyzed data from 135 patients who underwent ALIF for TLIF/PLIF cage removal between January 2019 and May 2023. Surgical indications included pseudarthrosis, cage migration, and infection. Outcomes assessed included intraoperative complications, surgical duration, and estimated blood loss.Results Of the 135 patients (median age: 47 years, range: 15–78), vascular injuries occurred in only 4 cases, all involving the left iliac vein, and were managed intraoperatively without sequelae. No injuries to retroperitoneal, neural, or organ structures were observed. Median surgical time was 100 minutes (range: 50–210), with most cases resulting in less than 150 mL of blood loss. These findings demonstrate the feasibility of ALIF for managing TLIF/PLIF complications.Conclusion ALIF is a safe and effective option for revision surgeries involving TLIF/PLIF cage removal, offering a low complication profile and manageable intraoperative challenges. A critical factor contributing to these favorable outcomes is the multidisciplinary approach, where the collaboration between access and spine surgeons ensures meticulous handling of anatomical and vascular challenges.Clinical Relevance This study provides valuable data for further prospective research to explore long-term outcomes and refine surgical techniques.Level of Evidence 4.