Oblique lumbar interbody fusion for revision of non-union following prior posterior surgery: a case report

We report the case of a 75-year-old lady who presented with a L_2-3 non-union 18 months following a L_2-3 and L_3-4 posterior decompression and transforaminal lumbar interbody fusion. Halo of the L₂ pedicle screws on imaging was consistent with a non-union at the L_2-3 level. An anterior lumbar interbody fusion (ALIF) approach was originally considered. However, due to the high lumbar approach and patient habitus [body mass index (BMI) > 35], a decision was made to approach the L_2-3 level using an oblique technique. This involved dissection anterior to the psoas muscle to access the L_2-3 disc space. The psoas, kidney and retroperitoneum were retracted using a Synframe for the oblique trajectory. Removal of the prior trans-foraminal lumbar interbody fusion cage was performed via the oblique approach and insertion of a revised implant. The operation was completed successfully with no perioperative complications noted. Length of stay was 3 days, with the patient achieving rapid pain relief. In the present report, we report the first case using an oblique lumbar interbody fusion (OLIF) approach for revision of a prior posterior fusion non-union at the L_2,3 level. The OLIF technique is feasible for revision of a non-union of upper lumbar levels, with satisfactory fusion achieved with acceptable feasibility.