ABSTRACT
Anterior lumbar interbody fusion (ALIF) is a powerful tool for the spine surgeon—one that affords opportunities for direct and indirect neural decompression, reduction of spondylolisthesis, and a large surface for fusion. Indications for revision of ALIF nonunions include pain related to the nonunion, hardware failure with resultant three-column instability, and graft/cage displacement, subsidence, or resorption—the complications of which may result in symptomatic positive sagittal balance. Revision surgery can be fraught with challenges, including scarred tissue planes, poorly mobile vasculature, bone loss, and excessive fibrous tissue within the interbody space. Preoperative planning begins with a focused assessment of the patient's complaints and correlation with the lumbar level of concern. The etiology of nonunion should be ascertained, and, if possible, optimized prior to undertaking a revision operation. Patients with diabetes should have a baseline hemoglobin A1c measured to assess historical glycemic control.
