Use of Anterior Lumbar Interbody Fusion as a Revision Approach Following Failed Posterior Instrumented Lumbar Fusion: A Case Report

A suitable option for revision surgery for posterior approach that permits avoiding fibrosis is the anterior lumbar interbody fusion (ALIF), which is also used to treat painful degenerative disc disease and restore the sagittal balance of the spine. A 64-year-old female patient presented with a 20-year history of lumboradiculopathy. She had undergone a treatment of therapeutic facet and foraminal block of L4-L5, L5-S1, left laminoforaminotomy L4-L5, right L5-S1 and posterior lumbar interbody fusion L4-L5 and L5-S1. During the procedure, a fistula was identified in the L5-S1 space. Therefore, it was decided to maintain the level without interbody fusion. She came to our medical unit three months after the last instrumentation, complaining of pain in the lumbar region with radiation to the left leg, which is disabling and limits her activities of daily living. Cabinet studies showed posterior instrumentation from L4 to S1, lateral interbody cage at L4-L5, L4-L5, Meyerding grade I spondylolisthesis with instability in the sagittal plane of L5-S1, and lateral recess stenosis left L5-S1. An L5-S1 anterior lumbar interbody fusion was performed and bars and screws from S1 were removed via a posterior approach. This led to a radiological improvement by achieving an adequate sagittal balance. Patient's symptoms and pain were reduced by indirectly performing decompression of the spinal nerve. The procedure did not have any complications. This case emphasizes the importance of presurgical planning in multi-treated patients with previous fusions without improvement and the choice of an anterior lumbar interbody fusion, which shows greater safety, clinical and radiological improvement for patients.