Retrieval of a migrated AxiaLIF lumbosacral screw using fluoroscopic guidance with simultaneous real-time sigmoidoscopy: technical report.

ABSTRACT

STUDY DESIGN: Technical report. OBJECTIVE: This article describes the technique of using intraoperative sigmoidoscopy as an adjunct for retrieval of the AxiaLIF lumbosacral screw after failure of lumbar fusion. SUMMARY OF BACKGROUND DATA Minimally invasive axial lumbar interbody fusion devices have emerged during the past 3 years as an alternative to traditional surgery for the treatment of intractable back pain. No reports of inferior migration of the lumbosacral screw causing rectal symptoms have been previously described. A 32-year-old firefighter with intractable lumbar back pain was treated with minimally invasive axial lumbar interbody fusion with L4-S1 pedicle screw fixation. Sequential images obtained for more than 18 months demonstrated loosening and migration of the axial screw 3.5 cm inferiorly causing impression on the rectum and symptoms of tenesmus. METHODS: Preoperative sigmoidoscopy was performed to exclude rectal perforation. During retrieval of the lumbosacral screw, simultaneous sigmoidoscopy was performed to ensure the rectum was not damaged. RESULTS: The lumbosacral screw was successfully removed using a presacral approach. The patient's rectal symptoms improved postoperatively, and was discharged after 48 hours. CONCLUSION: For the retrieval of migrated AxiaLIF lumbosacral screws, intraoperative sigmoidoscopy is technically feasible and serves as a useful adjunct to ensure the integrity of the rectal mucosa is maintained. This technique can be used to avoid the potential morbidity of rectal perforation, and subsequent laparotomy and defunctioning colostomy. LEVEL OF EVIDENCE N/A.