ABSTRACT
This chapter provides a basic framework to assess and manage the rare complication of ventrally extruded grafts. The most common interbody fusion techniques include anterior lumbar interbody fusion (ALIF), oblique lateral interbody fusion, transforaminal lumbar interbody fusion, posterior lumbar interbody fusion, and direct lateral interbody fusion. Ventral graft extrusion is most effectively addressed by an anterior approach, as it allows direct visualization of the graft and careful dissection for removal. In the case of revision fusion, a stand-alone ALIF is not recommended. Formal posterior fixation with pedicle screw instrumentation, cortical screw fixation, or spinous process plating is recommended. Retrograde ejaculation from injury to the superior hypogastric plexus can occur from both mechanical and inflammatory reactions near the plexus. Intraoperative neurophysiological monitoring should be used to avoid traction injury during graft placement. Creating a wide discectomy allows the ALIF graft to span any defect created by the prior disc prep.
