Background

Current revision surgery to remove the infected interbody cage following transforaminal lumbar interbody fusion (TLIF) surgery is challenging and traumatic. The purpose of this study is to introduce a novel surgical technique to remove the infected interbody cage for chronic infection.

Methods

Three patients with chronic infection following TLIF surgery underwent revision surgery. Instrumentations were removed and a spinal endoscope was obliquely inserted to the disc space through the initial annular breach. Under endoscope, the cage was found, released, turned around, and dragged to the posterior edge of the disc space. The cage was then removed without distracting the dural sac and nerve roots. For two cases, appropriately sized structural iliac bone grafts were used for interbody fusion without extra instrumentations.

Results

Using endoscope, the interbody cage was easy to identify and expose without disrupting the dural sac and nerve roots. With various endoscopic tools, the cage was easily released and removed. In this case series, the infected interbody cage was removed within thirty minutes without dural sac rupture and nerve root injury. The infection was controlled after the surgery, and the patients obtained good clinical outcomes. At 6-month follow-up, bony fusion was achieved in two patients who underwent interbody fusion.

Conclusions

This endoscopy assisted technique simplified the revision surgery for chronic infection followed TLIF surgery, with the advantages of no disruption of the neural tissues, bright surgical field and complete disc debridement.

中文翻译：

---

腰椎翻修手术中使用内窥镜去除感染的椎间融合器：病例系列和技术报告

 背景

目前，经椎间孔腰椎椎间融合（TLIF）手术后移除感染的椎间融合器的翻修手术具有挑战性且具有创伤性。本研究的目的是介绍一种新颖的手术技术来去除慢性感染的感染椎间融合器。

 方法

TLIF 手术后出现慢性感染的 3 名患者接受了翻修手术。移除器械并将脊柱内窥镜通过最初的环形缺口倾斜插入椎间盘间隙。在内窥镜下，找到融合器，释放，转动，拖至椎间盘间隙的后缘。然后在不干扰硬脑膜囊和神经根的情况下移除笼子。对于两个病例，使用适当尺寸的结构性髂骨移植物进行椎间融合，无需额外的器械。

 结果

使用内窥镜，椎间融合器很容易识别和暴露，而不会破坏硬膜囊和神经根。使用各种内窥镜工具，可以轻松释放和移除笼子。在该病例系列中，受感染的椎间融合器在三十分钟内被移除，没有硬膜囊破裂和神经根损伤。术后感染得到控制，患者获得良好的临床效果。在 6 个月的随访中，两名接受椎间融合术的患者实现了骨融合。

 结论

该内镜辅助技术简化了TLIF手术后慢性感染的翻修手术，具有不破坏神经组织、手术视野明亮、椎间盘清创彻底等优点。