Endoscopic Revision for Long‐Term Symptomatic Cage Retropulsion after TLIF: The Clinical Presentation in a Single Center

Abstract

Background Cage retropulsion after transforaminal lumbar interbody fusion (TLIF) is a common complication that is more frequently detected in the early postoperative period. Revision in the early stages is relatively less difficult in symptomatic cases. However, cage retropulsion is quite rare for patients with intervertebral osseous fusion in the long term after TLIF, and there are no relevant reports related to the revision plan. Case presentation Here, we report a case of a patient who underwent L4‐S1 TLIF at another hospital 4 years ago, accompanied by recurrent pain and discomfort of the left lower limb after the operation. Due to recent condition aggravation, it was considered to be caused by compression of the nerve root due to cage retropulsion. Nerve root sealing and endoscopy surgery were performed on the operative segment. It was found that cage retropulsion at the L4/5 level was a suspicious focus according to careful analysis of the clinical manifestations of the patient. Selective block of the nerve root on the level resulted in relief of the patient's original symptoms. After the posterior edge of the cage was exposed under the endoscope through an intervertebral foramen approach, the posterior edge of the cage protruding into the spinal canal was removed by high‐speed burr grinding, working casing reduction and other methods. Postoperative symptoms of pain in the low back and lower limb were relieved completely. Conclusions It is feasible to use the power system to remove the retrograde cage under the endoscope through the intervertebral foramen approach for the revision of symptomatic polyether ether ketone (PEEK) cage retropulsion in the long term after TLIF.

Endoscopic Resection and Decompression for Lateral Displacement of Cage after Oblique Lumbar Interbody Fusion: A Case Report from a Single Center

“…Telfeian et al reported eight cases of posterior displacement of cage compressing the spinal canal and were endoscopically revised with transforaminal approach 4 . Xu et al described endoscopic revision technique for cage retropulsion after transforaminal lumbar interbody fusion 5 . However, lateral displacement of cage after OLIF was more rarely seen and would also cause neuromuscular symptoms 2 .…”

“… 4 Xu et al described endoscopic revision technique for cage retropulsion after transforaminal lumbar interbody fusion. 5 However, lateral displacement of cage after OLIF was more rarely seen and would also cause neuromuscular symptoms. 2 A few papers have reported that open surgery through the posterior approach was used to manage this complication.…”