Application of Lateral Approach for the Removal of Migrated Interbody Cage: Taphole and Fixing Technique

Eom, Jae Sung; Jeon, Ikchan; Kim, Sang Woo

doi:10.14245/kjs.2017.14.1.23

Cited by 6 publications

(6 citation statements)

References 13 publications

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“…A high-speed burr can be used to obliterate interbody spacers made of bone or polyether ether ketone (PEEK) but not metallic cages. Eom et al described a technique for the removal of difficult-to-remove PEEK interbody cages: a tap hole is created into which a rod with a threaded tip is screwed to function as a joystick to control the cage for removal [3]. If the geometry and orientation of the original TLIF cage allow for insertion of a second, revision TLIF can be performed using a contralateral approach.…”

Section: Resultsmentioning

confidence: 99%

Surgical Strategies for the Treatment of Lumbar Pseudarthrosis in Degenerative Spine Surgery: A Literature Review and Case Study

Derman

Singh

2020

HSS Journal®: The Musculoskeletal Journal of Hospital for Speci

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Background Pseudarthrosis after lumbar fusion can generate pain and disability and often requires revision. However, results of revision procedures have historically been relatively poor. Questions/Purpose The aim of this review was to examine the current evidence related to the management of lumbar pseudarthrosis, with a focus on revision after failure of posterolateral fusion or lumbar interbody fusion. Methods A review of orthopedic spine literature published before March 2019 was conducted using PubMed and Google Scholar. Studies addressing revision after failed posterolateral fusions and after failed interbody fusion were selected. We also present a case of successful revision after failed transforaminal lumbar interbody fusion (TLIF). Results The review revealed that persistent pseudarthrosis after revision posterolateral fusion occurs at rates of 35 to 51%. No significant difference has been demonstrated in rates of successful fusion after anterior lumbar interbody fusion (ALIF) and ALIF with revision posterolateral fusion for pseudarthroses after failed TLIF procedures (81% versus 88%), although ALIF alone may be appealing because it avoids further disruption of the posterior musculature. No significant differences have been observed in quality-of-life scores among patients undergoing revision after posterolateral fusion, TLIF, ALIF, or ALIF with posterior fusion. Failed TLIF cages may be extracted and replaced through an anterior or lateral approach. If the geometry of the failed cage permits insertion of a second cage, a contralateral approach may be used. Revision retroperitoneal approaches are associated with higher complication rates. Conclusions The management of lumbar pseudarthrosis requires careful planning, as well as intra-operative attention to detail, for revision surgery to be successful. Circumferential procedures have shown success in revision posterolateral and interbody fusion failures.

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Section: Resultsmentioning

confidence: 99%

Surgical Strategies for the Treatment of Lumbar Pseudarthrosis in Degenerative Spine Surgery: A Literature Review and Case Study

Derman

Singh

2020

HSS Journal®: The Musculoskeletal Journal of Hospital for Speci

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“…[ 2 ] Most commonly, lateral retroperitoneal or anterior transperitoneal approaches are recommended for cage extraction. [ 3 ]…”

Section: Discussionmentioning

confidence: 99%

Delayed asymptomatic retroperitoneal dislodgement into the pouch of Douglas of a TLIF cage: A case report and review of the literature

Kumar¹,

Kaucha²,

Adsul³

et al. 2021

Surgical Neurology International

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Background: Intraoperative anteropulsion of a transforaminal lumbar interbody fusion (TLIF) cage is infrequent but may have disastrous complications. Here, we present an 80-year-old female whose L5-S1 TLIF cage extruded anteriorly and later migrated into the pouch of Douglas (i.e. an anterior peritoneal reflection between the uterus and the rectum) posing potential significant risks/complications, particularly of a major vessel injury. Notably, this 80-year-old patient with degenerative lumbosacral scoliosis should have only undergone a lumbar decompression alone. Case Description: An 80-year-old female underwent a two-level L4-L5 and L5-S1 TLIF to address lumbosacral canal stenosis with degenerative scoliosis. During the L5-S1 TLIF, intraoperative fluoroscopy showed the anterior displacement of the cage ventral to the sacrum. As she remained hemodynamically stable, the cage was left in place. The postoperative CT scan confirmed that the cage was located in the retroperitoneum but did not jeopardize the major vascular structures. Three months later, however, the cage migrated inferiorly into the pouch of Douglas. Although asymptomatic, general surgery and gynecology advised laparoscopic removal of the cage to avoid the potential for a major vessel/bowel perforation. However, the patient refused further surgery, and 3 years later remained asymptomatic. Conclusion: Anterior cage migration following TLIF has been rarely reported. In this case, an L5-S1 TLIF cage extruded anteriorly in an 80-year-old severely osteoporotic female and migrated 3 months later into the pouch of Douglas, posing the risk of a major vessel/bowel injury. Although surgical removal was recommended, the patient refused further surgery but remained asymptomatic 3 years later. Notably, the authors, in retrospect, recognized that choosing to perform a 2-level TLIF in an 80-year-old female reflected poor judgment.

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“…Despite its rare occurrence, the consequences of cage retropulsion are disabling to the patient, and revision surgery is technically challenging with epidural fibrosis and scarring from prior surgical intervention. Hence, some surgeons have even retrieved the cages with a lateral, anterior, and even transdural approach [16-18]. All these have significant risk of iatrogenic complications.…”

Section: Discussionmentioning

confidence: 99%

Mimickers in Spine: Migrated Cages Causing Radiculopathy

Nanda

Jain

Behera

et al. 2019

Case Rep Orthop Res

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The procedure of interbody fusion has become an established treatment for many spine disorders. This arthrodesis can be achieved by hardware (fusion cage) through many approaches. Initially, posterior lumbar interbody fusion was popularized but had some serious neurological complications related to insertion as well as the migration of the cage. Gradually, transforaminal lumbar interbody fusion (TLIF) was introduced, which proved safer as it involves minimal cord handling, and also migration, if any, remains asymptomatic. We had two patients who were operated for interbody fusion using TLIF technique with subsequent posterior migration of the banana-shaped fusion cage 4-6 month after the index surgery. Both patients presented with radiculopathy mimicking a prolapsed intervertebral disc. These were evaluated and operated with the removal of the migrated cages and revision with bigger-size cages with adequate bone grafting. At the 1-year follow-up, both had remission of symptoms, and radiographs showed no subsequent migration. TLIF procedure is an established procedure to achieve arthrodesis in varying spine disorders with promising result. However, there are only a few reports describing cage migration after the procedure and these have been asymptomatic. Revision surgery is contemplated in the setting of neurological compression or instability. A bigger fusion cage in a compressive mode with adequate bone grafting is used to achieve arthrodesis. The principles of interbody fusion must be followed, and utmost precautions must be taken to prevent this unfortunate complication.

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Application of Lateral Approach for the Removal of Migrated Interbody Cage: Taphole and Fixing Technique

Cited by 6 publications

References 13 publications

Surgical Strategies for the Treatment of Lumbar Pseudarthrosis in Degenerative Spine Surgery: A Literature Review and Case Study

Surgical Strategies for the Treatment of Lumbar Pseudarthrosis in Degenerative Spine Surgery: A Literature Review and Case Study

Delayed asymptomatic retroperitoneal dislodgement into the pouch of Douglas of a TLIF cage: A case report and review of the literature

Mimickers in Spine: Migrated Cages Causing Radiculopathy

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