Posterior Revision of Lumbar Interbody Fusion Cages Migration: Clinical Case Series and Literature Review

Background Data: Revision surgery for lumbar interbody cage migration is technically demanding.Cage related complication may lead to failure of fusion. Revision of such morbidity is associated with increased risk of permanent neurological insult. Purpose: To analyze the efficacy of posterior approa...

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Autores principales:	Ayman Galhom, Ahmed Elsawaf, Mohamed Khattab
Formato:	article
Lenguaje:	EN
Publicado:	Egyptian Spine Association 2017
Materias:	posterior lumbar interbody fusion cage migration posterior approaches failed back surgery Neurology. Diseases of the nervous system RC346-429
Acceso en línea:	https://doaj.org/article/90afe4d7650a43b78fe91f2842e5cad0
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spelling	oai:doaj.org-article:90afe4d7650a43b78fe91f2842e5cad02021-12-02T03:41:43ZPosterior Revision of Lumbar Interbody Fusion Cages Migration: Clinical Case Series and Literature ReviewDOI:10.21608/ESJ.2017.67542314-89502314-8969https://doaj.org/article/90afe4d7650a43b78fe91f2842e5cad02017-07-01T00:00:00Zhttp://www.esj.journals.ekb.eg/article_6754.htmlhttps://doaj.org/toc/2314-8950https://doaj.org/toc/2314-8969Background Data: Revision surgery for lumbar interbody cage migration is technically demanding.Cage related complication may lead to failure of fusion. Revision of such morbidity is associated with increased risk of permanent neurological insult. Purpose: To analyze the efficacy of posterior approach and iliac crest auto grafting technique in revision of migrated intervertebral cages. Study Design: Retrospective descriptive clinical case study. Patients and Methods: From January 2010 to January 2016, we operated 106 patients underwent posterior lumbar interbody fusion (PLIF) with single cage application per level for treatment of degenerative spondylolisthesis. Of these, 12 patients experiencing cage subsidence and retropulsion. In subsidence, it was graded from 0 to III. Retropulsion was considered if the cage beyond the level of the posterior longitudinal line of the index two vertebrae. Patients were assessed pre-operatively for pain and clinical functional outcome by visual analogue scale (VAS) and Oswestry disability index (ODI), respectively. Patient with VAS score ≥5; at least 20% deterioration on ODI or with the superadded neurological deficit was considered candidates for revision surgery. Results: Cage migration incidence was 11.3%, with subsidence (6.7%), and retropulsion (4.6%) of all patients. The average time for subsidence was 3.3 months (range 2 to 6 months). Five patients with grade-II and III subsidence underwent revision surgery for foraminal decompression, augmenting fixation and adding postero-lateral iliac crest bone graft. Retropulsion was encountered in 4 patients and all needed revision surgery for cage retrieval and redo fusion. Grade-I subsidence could be treated conservatively. All surgically treated patients had a good result in VAS and ODI after a second surgery which maintained during follow up with P<0.05. Conclusion: Migration of posterior lumbar interbody fusion cage into the endplates or spinal canal is usually associated with patient dissatisfaction. Revision surgery indicated for cage retropulsion or high-grade subsidence. The posterior approach is technically demanding, safe, and effective for cage migration revision surgery. (2017ESJ141)Ayman Galhom Ahmed Elsawaf Mohamed KhattabEgyptian Spine Associationarticleposterior lumbar interbody fusioncage migrationposterior approachesfailed back surgeryNeurology. Diseases of the nervous systemRC346-429ENEgyptian Spine Journal, Vol 23, Iss 1, Pp 13-22 (2017)
institution	DOAJ
collection	DOAJ
language	EN
topic	posterior lumbar interbody fusion cage migration posterior approaches failed back surgery Neurology. Diseases of the nervous system RC346-429
spellingShingle	posterior lumbar interbody fusion cage migration posterior approaches failed back surgery Neurology. Diseases of the nervous system RC346-429 Ayman Galhom Ahmed Elsawaf Mohamed Khattab Posterior Revision of Lumbar Interbody Fusion Cages Migration: Clinical Case Series and Literature Review
description	Background Data: Revision surgery for lumbar interbody cage migration is technically demanding.Cage related complication may lead to failure of fusion. Revision of such morbidity is associated with increased risk of permanent neurological insult. Purpose: To analyze the efficacy of posterior approach and iliac crest auto grafting technique in revision of migrated intervertebral cages. Study Design: Retrospective descriptive clinical case study. Patients and Methods: From January 2010 to January 2016, we operated 106 patients underwent posterior lumbar interbody fusion (PLIF) with single cage application per level for treatment of degenerative spondylolisthesis. Of these, 12 patients experiencing cage subsidence and retropulsion. In subsidence, it was graded from 0 to III. Retropulsion was considered if the cage beyond the level of the posterior longitudinal line of the index two vertebrae. Patients were assessed pre-operatively for pain and clinical functional outcome by visual analogue scale (VAS) and Oswestry disability index (ODI), respectively. Patient with VAS score ≥5; at least 20% deterioration on ODI or with the superadded neurological deficit was considered candidates for revision surgery. Results: Cage migration incidence was 11.3%, with subsidence (6.7%), and retropulsion (4.6%) of all patients. The average time for subsidence was 3.3 months (range 2 to 6 months). Five patients with grade-II and III subsidence underwent revision surgery for foraminal decompression, augmenting fixation and adding postero-lateral iliac crest bone graft. Retropulsion was encountered in 4 patients and all needed revision surgery for cage retrieval and redo fusion. Grade-I subsidence could be treated conservatively. All surgically treated patients had a good result in VAS and ODI after a second surgery which maintained during follow up with P<0.05. Conclusion: Migration of posterior lumbar interbody fusion cage into the endplates or spinal canal is usually associated with patient dissatisfaction. Revision surgery indicated for cage retropulsion or high-grade subsidence. The posterior approach is technically demanding, safe, and effective for cage migration revision surgery. (2017ESJ141)
format	article
author	Ayman Galhom Ahmed Elsawaf Mohamed Khattab
author_facet	Ayman Galhom Ahmed Elsawaf Mohamed Khattab
author_sort	Ayman Galhom
title	Posterior Revision of Lumbar Interbody Fusion Cages Migration: Clinical Case Series and Literature Review
title_short	Posterior Revision of Lumbar Interbody Fusion Cages Migration: Clinical Case Series and Literature Review
title_full	Posterior Revision of Lumbar Interbody Fusion Cages Migration: Clinical Case Series and Literature Review
title_fullStr	Posterior Revision of Lumbar Interbody Fusion Cages Migration: Clinical Case Series and Literature Review
title_full_unstemmed	Posterior Revision of Lumbar Interbody Fusion Cages Migration: Clinical Case Series and Literature Review
title_sort	posterior revision of lumbar interbody fusion cages migration: clinical case series and literature review
publisher	Egyptian Spine Association
publishDate	2017
url	https://doaj.org/article/90afe4d7650a43b78fe91f2842e5cad0
work_keys_str_mv	AT aymangalhom posteriorrevisionoflumbarinterbodyfusioncagesmigrationclinicalcaseseriesandliteraturereview AT ahmedelsawaf posteriorrevisionoflumbarinterbodyfusioncagesmigrationclinicalcaseseriesandliteraturereview AT mohamedkhattab posteriorrevisionoflumbarinterbodyfusioncagesmigrationclinicalcaseseriesandliteraturereview
_version_	1718401682928304128

Posterior Revision of Lumbar Interbody Fusion Cages Migration: Clinical Case Series and Literature Review

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