Abstract:
STUDY DESIGN:A case report of 3 patients with posterior migration of bullet-shaped fusion cages after transforaminal lumbar interbody fusion (TLIF). One patient required emergency revision surgery; the other 2 patients are being observed during conservative treatment. OBJECTIVE:To review cases of posterior migration of fusion cages and report ensuing clinical courses. SUMMARY OF BACKGROUND DATA:TLIF is a commonly used procedure; however, there are few reports describing cage migration after the procedure. In most cases, when posterior cage migration follows posterior lumbar interbody fusion, emergency revision surgery is required. One recent study reported a case of posterior cage migration after TLIF, which was treated conservatively. METHODS:Posterior migration of the bullet-shaped fusion cages occurred 1 to 2 months after TLIF in 3 patients. One of the 3 patients had isthmic spondylolisthesis treated by TLIF with bilateral pedicle screw fixation. The other 2 patients had degenerative scoliosis and were treated by TLIF with unilateral pedicle screw fixation. RESULTS:The patient with isthmic spondylolisthesis required revision surgery because the migrated cage caused nerve root irritation. The migrated cage was removed and a large-sized cage was employed to achieve stability. The other 2 patients had no pathologic symptoms after the posterior migration of the cage and were treated conservatively and observed. CONCLUSION:Revision surgery after TLIF appears relatively safe because the migrated cage tends to locate more laterally than in patients with cage migration after posterior lumbar interbody fusion. Cage migration subsequent to TLIF may not cause compression of neural tissues, so conservative treatment may suffice for these patients. Unilateral pedicle screw fixation may not provide sufficient stability to prevent cage migration in patients with degenerative scoliosis. Further study is needed to clarify surgical indications for unilateral pedicle screw fixation in TLIF.
journal_name
Spine (Phila Pa 1976)journal_title
Spineauthors
Aoki Y,Yamagata M,Nakajima F,Ikeda Y,Takahashi Kdoi
10.1097/BRS.0b013e3181918aaesubject
Has Abstractpub_date
2009-01-01 00:00:00pages
E54-8issue
1eissn
0362-2436issn
1528-1159pii
00007632-200901010-00027journal_volume
34pub_type
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