Pseudarthrosis and Revision

Pseudarthrosis (or “nonunions”) is the movement of a bone resulting from inadequate healing. This movement may require replacement (revision) of the initial implanted instrumentation, a procedure that often poses unique challenges to spine surgeons. Indications for revision include:

  • Non-unions
  • Infection
  • Instrumentation failure

Depending on the access route chosen for the index operation, scarring along that route can be particularly problematic. This challenge may be magnified if posterior instrumentation needs to be removed and/or replaced.

The pre-sacral access route utilized by AxiaLIF was developed to minimize the potential of vascular and neurological damage during approach to the spine. In addition, the AxiaLIF implant provides immediate rigid fixation of the anterior column.

One design consideration for AxiaLIF was the ability to be effectively utilized when an existing construct requires extension to an adjacent level. In the example below, a 52 y/o M with prior femoral ring and posterior instrumentation presented with symptomatic progression of degenerative disc at L5-S1. The solution in this case was an AxiaLIF construct with facet screws posteriorly — the L4-L5 construct was left undisturbed.

Photos courtesy William D. Tobler MD, Mayfield Clinic and Spine Surgery Center, Cincinnati, OH