Intraoperative Antepulsion of a Fusion Cage in Posterior Lumbar Interbody Fusion: A Case Report and Review of the Literature

Abstract

The various types of spinal fusion operations are associated with specific complications. A through knowledge of the procedures and possible complications, as well as meticulous surgical technique, can help minimize these. Once complications do occur, prompt recognition and treatment should minimize the long-term sequelae.

Anterior Dislodgement of a Fusion Cage after Transforaminal Lumbar Interbody Fusion for the Treatment of Isthmic Spondylolisthesis

“…Several recent studies have described cases of posterior cage migration after TLIF procedures that were mostly associated with pseudoarthrosis19,22). However, there are few case reports about anterior migration or dislodgement, and the causes included perforation of the annulus fibrosus during the removal of the disc or a feeble condition by spondylodiscitis20,21). In which reports, migration was confirmed intraoperatively.…”

Effect of soft tissue thickness over the posterior border of the vertebral body and disc space on cage placement during posterior lumbar interbody fusion: A cadaveric study

“…To achieve these goals, a surgeon must take into consideration many factors including technical factors (proper endplate preparation and ideal positioning of the cage), implant factors (design and size), and patient factors (bone quality, metabolic condition, and accompanying diseases). Currently, the nature of proper cage positioning remains controversial, and thus it is imperative to achieve the aforementioned objectives (Proubasta et al,2002; Abbushi et al,2009; Pawar et al,2010). For these reasons, surgeons often utilize image intensifiers to verify the exact placement of cages; however, use of such image intensifiers during procedures is associated with several limitations.…”

“…Indeed, improper positioning of cages can cause complications. Specifically, if a cage is positioned excessively anteriorly, it can result in vessel and organ injury, whereas problems such as nonunion, migration, and neurological complications can occur in cages placed excessively posterior (Proubasta et al,2002; Pawar et al,2010). Such serious clinical complications can be avoided by paying careful attention during cage insertion through the use of image intensifiers or radiography.…”

Discectomia lombar transforaminal: estudo quantitativo em cadáveres

“…Além disso, permite-se restaurar a altura discal, corrigindo e mantendo o alinhamento lombar, mesmo em pacientes com osteoporose. Entretanto, para realizar artrodese 360º, é necessária a remoção discal pela via posterior ou póstero-lateral e colocação de um dispositivo ou enxerto ósseo no espaço intersomático, tendo o risco de pseudoartrose aumentado por conta de permanência de tecido discal no espaço [4][5][6][7] . Baseado nestes fatos, houve, nos últimos anos, um incremento no número de artrodeses circunferenciais pela via posterior, usando a via transfacetária unilateral (TLIF) como acesso ao disco, e com menos complicações que a póstero-lateral bilateral (PLIF).…”

“…Outras desvantagens incluem a dificuldade para completa remoção discal e preparação adequada da placa vertebral quando não há visualização do espaço discal na íntegra. Há evidência experimental de que a persistência de material discal residual é um fator para desenvolvimento de pseudoartrose [4][5][6][7] . A artrodese lombar por via anterior tem como vantagens a preservação da musculatura posterior, preservação do canal vertebral, sem retração dural ou radicular, e maior facilidade de remoção discal e preparação da placa vertebral para artrodese.…”