Intraoperative antepulsion of a posterior lumbar interbody fusion cage: three case reports

Ceylan, Davut; Yaldız, Can; Asil, Kıyasettin; Kacira, Tibet; Tatarlı, Necati; Can, Aytaç

doi:10.11604/pamj.2015.20.342.5750

Cited by 9 publications

(18 citation statements)

References 12 publications

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“…9 Migration to the retroperitoneal region is a rare condition in the literature, and almost all the case reports are about posterior lumbar interbody fusion cages, with a small number of cases reporting TLIF cages dislodgement. 1,2,6,8 Some risk factors for cage migration were identified: advanced age, low bone mineral, small cages, oversized cages, rectangular-shaped cages, excessive curettage with tearing of the anterior longitudinal ligament (ALL) and strong impactation. 1,2,6,8,9 Technical errors by inexperienced spine surgeons were one of the main causes found for this complication.…”

Section: Discussionmentioning

confidence: 99%

“…1,2,6,8 Some risk factors for cage migration were identified: advanced age, low bone mineral, small cages, oversized cages, rectangular-shaped cages, excessive curettage with tearing of the anterior longitudinal ligament (ALL) and strong impactation. 1,2,6,8,9 Technical errors by inexperienced spine surgeons were one of the main causes found for this complication. The anterior longitudinal ligament attaches firmly to the anterior surface of the vertebrae and is not as strong on the lateral side.…”

Section: Discussionmentioning

confidence: 99%

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Iliac vein injury after anterior transforaminal lumbar interbody fusion cage migration

et al. 2021

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<p>Transforaminal lumbar interbody fusion (TLIF) is an effective treatment for many spine conditions. Anterior cage migration is one of the known complications and major vessels injury after that is a rare but potentially disastrous complication. We present a case of a 65-year-old female patient who underwent a TLIF for the treatment of an instable low grade spondylolisthesis. During the procedure, anterior dislodgment of the cage was verified and it was not possible to retrieve it by this approach. Has no bleeding or change in hemodynamical status was verified, it was decided not to proceed to removal at that moment. A CT-scan was performed and showed the position of the cage migrated through the posterior wall of the confluence of the left internal and external iliac veins. A new surgery was performed by an anterior approach to remove the cage and repair the vessel injury, by a vascular surgeon. In this case, cage migration occurred mostly because of implant malfunction. Surgeons must be aware that anterior cage migration can cause vascular injuries, and removal of this implants is effective by an anterior approach but a vascular surgeon must be part of the team.</p>

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Iliac vein injury after anterior transforaminal lumbar interbody fusion cage migration

et al. 2021

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“…When the cage does not compress large vessels or other intraabdominal organs, observation is an option. Ceylan et al 6 reported 3 cases of conservative treatment for cage dislodgement and claimed that early cage removal was not necessary unless an intraabdominal organ or vascular injury developed. However, there are some cases in which a misplaced screw or migrated bone grafts have caused compression and irritation, resulting in a postoperative deep vein thrombosis or aortic pseudoaneurysm, and the risk of leaving a dislodged cage in place remains unclear.…”

Section: Discussionmentioning

confidence: 99%

“…However, cage dislodgement occurred in 1 of our cases, and Ceylan et al reported 3 cage dislodgements under fluoroscopy control. 6 We must keep in mind that fluoroscopy control does not prevent anterior cage dislodgement perfectly.…”

Section: Discussionmentioning

confidence: 99%

“…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.…”

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

Murase

Oshima

Takeshita

et al. 2017

Journal of Neurosurgery: Spine

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OBJECTIVEInterbody fusion cages are widely used to achieve initial fixation and secure spinal fusion; however, there are certain technique-related complications. Although anterior cage dislodgement can cause major vascular injury, the incidence is extremely rare. Here, the authors performed a review of anterior cage dislodgement following posterior lumbar interbody fusion (PLIF) surgery.METHODSThe authors retrospectively reviewed the cases of 4625 patients who had undergone PLIF at 6 institutions between December 2007 and March 2015. They investigated the incidence and causes of surgery-related anterior cage dislodgement, salvage mechanisms, and postoperative courses.RESULTSAnterior cage dislodgement occurred in 12 cases (0.26%), all of which were caused by technical errors. In 9 cases, excessive cage impaction resulted in dislodgement. In 2 cases, when the cage on the ipsilateral side was inserted, it interacted and pushed out the other cage on the opposite side. In 1 case, the cage was positioned in an extreme lateral and anterior part of the intervertebral disc space, and it postoperatively dislodged. In 3 cases, the cage was removed in the same operative field. In the remaining 9 cases, CT angiography was performed postoperatively to assess the relationship between the dislodged cage and large vessels. Dislodged cages were conservatively observed in 2 cases. In 7 cases, the cage was removed because it was touching or compressing large vessels, and an additional anterior approach was selected. In 2 patients, there was significant bleeding from an injured inferior vena cava. There were no further complications or sequelae associated with the dislodged cages during the follow-up period.CONCLUSIONSAlthough rare, iatrogenic anterior cage dislodgement following a PLIF can occur. The authors found that technical errors made by experienced spine surgeons were the main causes of this complication. To prevent dislodgement, the surgeon should be cautious when inserting the cage, avoiding excessive cage impaction and ensuring cage control. Once dislodgement occurs, the surgeons must immediately address this difficult complication. First, the possibility of a large vessel injury should be considered. If the patient’s vital signs are stable, the surgeon should continue with the surgery without cage removal and perform CT angiography postoperatively to assess the cage location. Blind maneuvers should be avoided when the surgical site cannot be clearly viewed. When the cage compresses or touches the aortic artery or vena cava, it is better to remove the cage to avoid late-onset injury to major vessels. When the cage does not compress or touch vessels, its removal is controversial. The risk factors associated with performing another surgery should be evaluated on a case-by-case basis.

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Anterior graft migration in posterior lumbar interbody fusion: A case report and literature review

Hashimoto,

Hirata,

Tsukamoto

et al. 2023

Clinical Case Reports

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Key Clinical MessageSpine surgeons should be aware of the possibility of anterior displacement of the grafted bone during PLIF and the potential for severe complications that may arise because of such displacement so that preparations can be made for a proper response.AbstractWe report two cases of anterior displacement of the grafted bone after posterior lumbar interbody fusion (Graphical Abstract A‐D). The patients did not require additional surgery. The anterior migration of grafted bone or cage can cause damage to anterior organs and blood vessels. Therefore, a careful surgical procedure is necessary.

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Intraoperative antepulsion of a posterior lumbar interbody fusion cage: three case reports

Cited by 9 publications

References 12 publications

Iliac vein injury after anterior transforaminal lumbar interbody fusion cage migration

Iliac vein injury after anterior transforaminal lumbar interbody fusion cage migration

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

Anterior graft migration in posterior lumbar interbody fusion: A case report and literature review

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