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Revision without touching existing screw/rods ???

davidwright242ddavidwright242 Posts: 32
edited 10/02/2014 - 8:59 AM in Back Surgery and Neck Surgery
I am facing a revision of a L4-L5 TLIF that did not fuse and I have recently returned from an appointment with an orthopedic surgeon. His suggestion was to do an OLIF (that's a side approach) and to remove the old cage/material and put in a larger cage.

What I am concerned about is that he has stated that he has no intention to adjust or do anything to the screws/rods during the procedure since they are solid with no lucencies. While this sounds good (yay less surgery!) I am concerned with just how solid a new cage can be and with how successful *forcing* a new cage between the vertebrae can be when the screws/rods are left in place.

While I know that people are not allowed to offer medical advice here, I am just curious if anyone has had a revision where existing rods and screws are left in place? Or if anyone has heard about leaving the screws and rods in place during a revision?


--) Dave (--
--) Dave (--


  • They can loosen the tension on the rods during the surgery without having to remove them if they need to to insert the new cage.
    Not having to remove or replace them is actually a good thing. A bigger cage doesn't necessarily mean that it is going to be much larger, just slightly bigger so that it holds in the space between the vertebra.
  • The surgeon has stated that he's not going to touch them however (I changed the post subject to that just now). He only plans on going to go in from the front, and has made no mention of going in from the back to physically loosen them, hence my concern.

    I have not heard of this method before so I am interested in hearing if this is a common approach. He stated that he would get the cage in there even if he had to hammer it in a bit.

    Do you mean they can loosen the tension on the rods without having to actually touch them etc? Like prying the vertebrae apart a bit or something?

    Since I have never heard of this before I am concerned a bit.
    --) Dave (--
  • davidwright242ddavidwright242 Posts: 32
    edited 10/02/2014 - 11:09 AM
    Now that I think about it, I do see why my doctor suggested this approach when the screws/rods are solid.

    From what I have read, people that have 360 revisions done almost have an anterior approach first (ALIF-XLIF etc) to access the front disc space, and then afterwards (the following day often) a posterior approach is often taken to replace screws etc as necessary. I guess when a cage is put in from the front it's going to have to be forced in there no matter what. . . I suppose this is just one of the complications of a revision.
    --) Dave (--
  • Dave
    How did you make out - how was recovery etc. My Surgeon did same procedure on my L5S1 revision. Front ALIF only , forced spacer without changing posterior hardware from TLIF Jan 2012 that never fused. Surgery was 12-4 trying to do my best to make thus one work and be last.
  • Not all fusion cages need to be forced, jammed or wedged into place. My TLIF was done with Caliber cages. As described by my surgeon, the device is slipped into place, then expanded so its faces can bite into the bone.
    August 2013 C7-T1 MED
    July 2013 L4-L5-S1 TLIF
    December 2011 C5-C6 ADR
    April 2009 L5-S1 MED
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