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Hindi Anterior migration of fusion cages in degenerative lumbar disease treated with transforaminal lumbar interbody fusion (TLIF): Surgical revision-a case report
Lorena Pena
Hospital Universitario Central de Asturias (Oviedo), Spain
: J Spine Neurosurg
Abstract
Introduction: The transforaminal lumbar interbody fusion (TLIF) is a commonly used procedure. However, there are some complications with this kind of surgery such as infection, non-union, posterior cage migration, and, very rarely, anterior migration of the cage. This complication has been reported only twice before in PubMed. Case Report: A 64-year-old man with degenerative scoliosis and lumbar spinal canal stenosis is presented. The surgery consisted of a L2-S1 arthrodesis with TLIF in L3-L4, L4-L5 and L5-S1 left. The immediate post-operative image was satisfying. The patient suffered sudden pain that radiated to the groin and kept him from walking one month after the surgery. Because of the lysis of the vertebral bodies L5 and S1, and the weight loss (27 kg), we thought it could be a tumoral or infectious process, so we did a lumbar MRI, TAC–PET, gammagraphy with technetium and leukocytes-marked with indium. Following the results, we decided to perform a two-stage revision surgery. Firstly, we did an anterior transperitoneal approach with the help of a vascular surgeon. We removed the anteriorly migrated cage and replaced it using another cage with allograft. Anteriorly, dislodgment of the TLIF cage is one of the most severe complications seen in this procedure and may cause an intraoperative major vessel injury. Secondly, we performed a posterior revision surgery two weeks later. The screws at S1 were found to be loose and were replaced with larger diameter ones. We then added two iliac screws to the construct. The patient showed almost complete recovery following the revision surgeries. Conclusion: In this kind of case it is very important to form a thorough differential diagnosis and rule out a tumoral or infectious process. A multidisciplinary approach with experienced surgeons is required to effectively treat an anteriorly displaced TLIF cage.
Biography
Lorena Pena has completed her PhD from University of Navarra; Spain and she is doing Post-doctoral studies from the University of Oviedo. She has presented more than 20 posters and oral communications in national and international congresses.
