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Published on: June 6, 2025
Laparoscopic surgery to remove a cage that migrated to the retroperitoneal space during posterior lumbar interbody
Takashi Okuyama1, Nobumi Tagaya1, Yoshitake Sugamata1
1Department of Surgery, Dokkyo Medical University Koshigaya Hospital, Koshigaya, Japan.
Introduction:
Cage migration into the retroperitoneal space during posterior lumbar interbody fusion rarely occurs. Here, we report a patient who underwent laparoscopic surgery to remove a migrated cage from the retroperitoneal space.
Case Presentation:
A 76-year-old woman had a cage that had migrated into the retroperitoneal space during posterior lumbar interbody fusion. On abdominal CT, the migrated cage appeared at the front of the promontorium, just below the aortic and vena caval bifurcations. One day later, the patient underwent laparoscopic surgery using intraoperative fluoroscopy to extract the migrated cage. The patient's postoperative course was uneventful, and she was discharged on the fifth postoperative day.
Discussion:
A cage that migrates during posterior lumbar interbody fusion can have serious consequences. In cases where the patient remains in stable condition, laparoscopic surgery is a useful and suitable method for removing the cage from the retroperitoneal space.
Insights
Retroperitoneal cage migration after posterior lumbar interbody fusion is rare. Laparoscopic surgery effectively removed a migrated cage, offering a safe treatment option for stable patients.
Area of Science:
- Spinal surgery
- Minimally invasive procedures
- Surgical complications
Background:
- Posterior lumbar interbody fusion (PLIF) is a common spinal procedure.
- Cage migration into the retroperitoneal space is a rare but serious complication of PLIF.
- Prompt diagnosis and intervention are crucial for managing such complications.
Observation:
- A 76-year-old female patient experienced PLIF cage migration into the retroperitoneal space.
- Abdominal CT revealed the cage positioned anterior to the promontorium, near major vascular structures.
- The patient underwent laparoscopic surgery for cage extraction.
Findings:
- Laparoscopic surgery successfully removed the retroperitoneal migrated cage.
- Intraoperative fluoroscopy guided the precise extraction.
- The patient experienced an uneventful postoperative recovery and was discharged on postoperative day 5.
Implications:
- Laparoscopic surgery is a viable and effective minimally invasive approach for retroperitoneal cage removal in stable patients.
- Early recognition and surgical intervention can prevent severe complications associated with migrated spinal implants.
- This case highlights the importance of vigilance for rare complications during and after spinal fusion procedures.
