Age / Sex : 65 / F

Chief complaint : left leg pain after fall down (onset: 2020-04-10)

History:

S/P PLIF, L3-4-5 (2020-03-11)

Left buttock, thigh pain은 수술 직후 호전

2020-04-10 걸어가다 좌측 무릎에 힘이 빠지며 넘어짐

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Courtesy : 정혜원(Chung, Hye Won), 서울아산병원 (Asan Medical Center)

Cage retropulsion after lumbar interbody fusion surgery

Discussion

Findings

1.Radiographs:

2020-03-15, S/P PLIF at L3-4-5 with normal range of position of cage

2020-04-24, newly developed posterior migration of L4-5 cage

2.MR: S/P PLIF, L3-4-5

Posterior misplacement of left cage at L4-5 level and located in left neural foramen, which may compressing left L4 nerve root

Cage Retropulsion after Lumbar Interbody Fusion Surgery

• Lumbar interbody fusion with cage

 - Fusion cage packed with auto-cancellous bone or allo-bone

 - Inserted into the disc space after vertebral endplate decortication

  → Restore the disc height with normal alignment

  → Spinal nerve root or compressed dural sac can be secondarily restored by increasing the disc height

• Cage retropulsion: major complication after LIF surgery

 - Incidence: 0.8% to 25%

 - Average onset time: 2.6 months (range 1-7 month)

 - Narrowing of the spinal canal or foraminal stenosis

 - Directly compress the dural sac or nerve root → Neurologic symptoms

• Revision surgery is technically demanding

 - because of the massive fibrosis of adjacent tissue

1.Asian Spine J 2018;12(1):59-68

2.J Neurosurg Spine 2010;13(3):381-7

3.Eur Spine J. 2009;18(11):1621-1628