# Two-stage surgical correction of L4/5 non-union using ALIF and endoscopic TLIF cage removal: a case report

## TL;DR

A two-stage surgical approach using ALIF and endoscopic cage removal successfully corrected a failed L4/5 fusion in a patient.

## Contribution

A novel two-stage surgical strategy combining ALIF and endoscopic TLIF cage removal is introduced for non-union cases.

## Key findings

- The two-stage approach achieved successful segmental stabilization and symptom relief.
- Endoscopic techniques enabled minimally invasive decompression and cage retrieval.
- No complications were encountered during or after the procedure.

## Abstract

Anterior lumbar interbody fusion (ALIF) offers a viable solution for failed posterior fusion procedures, including non-union following transforaminal lumbar interbody fusion (TLIF). This case report presents a novel two-stage corrective approach involving ALIF followed by endoscopic removal of a failed TLIF cage in a patient with L4/5 pseudarthrosis and persistent symptoms. Stage one involved placement of an ALIF cage with integral fixation, while stage two comprised minimally invasive endoscopic decompression and TLIF cage retrieval. The procedure was completed successfully without complications, resulting in improved neurological status, segmental stabilization, and symptomatic relief. This case illustrates a novel and effective surgical strategy for managing interbody non-union and highlights the role of endoscopic techniques in revision spine surgery.