Inferior vena cava injury caused by an anteriorly migrated cage resulting in ligation: case report

Abstract

<jats:p>Anterior dislodgement of the transforaminal lumbar interbody fusion (TLIF) cage is one of the severe complications seen in this procedure, which may cause an intraoperative major vessel injury. The objective of this report is to present a rare case of inferior vena cava (IVC) injury during revision surgery for removal of the anteriorly migrated cage.</jats:p> <jats:p>The authors describe a case of 74-year-old woman with lumbar spinal canal stenosis and degenerative scoliosis. During the TLIF surgery, an inserted titanium cage at the L4–5 level dislodged anteriorly to the retroperitoneal space without massive bleeding from the disc space. In the second surgery, which was performed via an anterior retroperitoneal approach to remove the migrated cage, massive torrential bleeding occurred because of IVC injury. The laceration in the posterior wall of the IVC necessitated ligation of this vessel and both common iliac veins by a vascular surgeon. Postoperative edema of the lower extremities after ligation of the vessels was well tolerated, and the patient showed almost full recovery.</jats:p> <jats:p>For removal surgery of an anteriorly migrated cage, the surgeon should be well prepared for the risk of IVC injury, including requesting the attendance of a vascular surgeon. Ligation of the infrarenal IVC is an acceptable solution in irreparable IVC injury.</jats:p>

Anterior cage dislodgement in posterior lumbar interbody fusion: a review of 12 patients

“…In this way, he/she can assist with the anterior portion of the procedure and contribute to planning the procedure if a major vascular injury is suspected. 3 In our cases, all cage dislodgements were due to technical errors, the most common of which was excessive cage impaction (9 cases). Anterior longitudinal ligaments at- tach firmly to the anterior surfaces of the vertebrae and are not strong on the lateral side.…”

“…4,15,20,24 However, the incidence of anterior cage dislodgement is extremely rare, and few cases have been reported. 3,6,7,21,22 Here, we report 12 cases of surgeryrelated anterior cage dislodgement; identify the cause, treatment, and postoperative course; and suggest how to deal with this complication based on our experience. To the best of our knowledge, this is the largest case series reported in the literature.…”

Cómo afrontar esta complicación: migración intraoperatoria de la caja anterior en L5-S1 resuelta con una técnica de fusión lumbar híbrida

“…PLIF is widely used for the treatment of mechanical low back pain, degenerative disc disease, recurrent disc herniation, and low-grade spondylolisthesis (grades I and II) with acceptable outcomes 2,5 . However, certain complications such as nerve root damage, dural tear, epidural fibrosis or arachnoiditis, cage subsidence, and migration have been reported 5 .…”

“…This technique provides support and stabilization of the spine 1 . There have been reports of high morbidity and mortality rates related to complications associated with cage placement, especially anterior migration with vascular injury [1][2][3] . Most of the cage displacements are posterior, and anterior cage migration is extremely rare 4 .…”

Iliac vein injury after anterior transforaminal lumbar interbody fusion cage migration

“…2 Anterior cage dislodgement can cause serious problems and although major vessel injury after spine surgery is an infrequent complication, it is associated with a high mortality rate. [3][4][5] We present a case of an anterior cage dislodgement with consequent iliac vein rupture.…”