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Recurrent Symptomatic Cage Migration After Minimally Invasive L4-5 TLIF.
Mazda K Turel1, Bhushan Meshram1
1Wockhardt Hospitals, Mumbai Central, Mumbai, India.
Acta Neurochirurgica. Supplement
|November 21, 2024
Summary
A patient experienced recurrent leg pain after lumbar fusion due to cage displacement. Revision surgery with bone grafting ultimately provided lasting pain relief, highlighting strategies to prevent cage backout.
Area of Science:
- Spine surgery
- Orthopedic surgery
- Neurosurgery
Background:
- Degenerative lumbar spine conditions can cause severe pain and radiculopathy.
- Minimally invasive spinal fusion, such as transforaminal lumbar interbody fusion (TLIF), is a common treatment.
- Cage migration (backout) is a potential complication following TLIF procedures.
Observation:
- A 70-year-old man with L4/5 degenerative listhesis and L5 radiculopathy underwent TLIF.
- Postoperatively, the patient experienced recurrent leg pain due to interbody cage displacement (backout).
Findings:
- Initial revision surgery with a larger cage and posterior fixation failed to prevent further cage migration.
- A second revision, involving cage removal and impaction with bone graft, successfully resolved the issue.
- The patient remained pain-free for 6 months post-final intervention.
Implications:
- This case underscores the challenges of managing cage backout after TLIF.
- Successful management involved bone grafting and potentially altered biomechanical forces.
- Further research into preventing cage migration in spinal fusion is warranted.
