Intraoperative antepulsion of a fusion cage in posterior lumbar interbody fusion: a case report and review of the literature.

Abstract

A case of intraoperative anterior migration into the abdominal cavity of a titanium fusion cage in the course of posterior lumbar interbody fusion. To explain the importance of a proper introduction of the fusion cages in the vertebral space and the necessity of intraoperative fluoroscopy study in both planes, frontal and lateral, respectively, to confirm the proper position of the implants. A potential serious complication of fusion cage instrumentation and the limited literature on this subject are reviewed. Early reports regarding fusion cage instrumentation have been encouraging. However, the potential benefits are better defined than the potential complications. A patient had anterior migration of a fusion cage intraoperatively in the course of posterior lumbar interbody fusion. One day later, the patient underwent surgical laparotomy to extract the migrated implant and a repeat posterior procedure that included bilateral posterior fusion with insertion of pedicle instrumentation. One year after the second operation, the patient remains pain-free, and no abdominal lesions or neurologic deficits were observed. 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.