Original ArticleTransforaminal Endoscopic Surgical Treatment for Posterior Migration of Polyetheretherketone Transforaminal Lumbar Interbody Fusion Cage: Case Series
Introduction
Transforaminal lumbar interbody fusion (TLIF) is a successful and widely performed surgical treatment for achieving 360-degree fusion of a lumbar motion segment. A fundamental part of the procedure is removing the lumbar disk and replacing it with bone and, often, a static or expandable interbody device that allows for maintained disk space and foraminal height while the motion segment undergoes fusion. Polyetheretherketone (PEEK) is a frequently used material for interbody devices due to its mechanical strength, modulus of elasticity, and radiolucency.
Studies have shown that the incidence of TLIF or posterior lumbar interbody fusion cage migration is between 1.17% and 14.7%, but, although the incidence is not extremely high, the adverse effects cannot be underestimated.1, 2, 3, 4 Cage migration can result in the loss of lumbar lordosis, narrowing of disk and foraminal height, lower fusion rates, compression of the dural sac, and, as treated here, compression of the nerve root and radicular pain and neurologic deterioration.
Section snippets
Methods
A retrospective study of 8 patients with lumbar radiculopathy in the setting of a retropulsed PEEK TLIF cage were included from January 2014 to January 2019. The inclusion criteria were 1) lumbar radiculopathy in the setting of a retropulsed PEEK TLIF cage causing nerve compression and 2) follow-up of at least 1 year. Patients were asked to complete the following questionnaires for outcome evaluation: visual analog scales (VAS) for leg pain and the Oswestry Disability Index (ODI). The Joimax
Results
Eight patients underwent transforaminal endoscopic surgery for treatment of radiculopathy in the setting of a retropulsed PEEK TLIF cage in the 5-year period evaluated (clinical data summarized in Table 1). One year after surgery, the VAS and ODI scores showed a significant decrease: Average preoperative VAS and ODI scores were 6.9 ± 1.2 and 50.5 ± 10.9, and 1-year postoperative VAS and ODI scores were 2.3 ± 1.3 and 17.3 ± 5.1 (see Table 1). There were no complications. All patients were
Case Example 1
The patient presented is a 48-year-old female who underwent a minimally invasive L5-S1 TLIF and subsequent partial hardware removal by another surgeon 10 years prior. She presented with 10 years of a left L5-S1 radiculopathy and foot dorsiflexion and plantarflexion weakness. Her preoperative lumbar magnetic resonance imaging and lumbar CT myelogram demonstrated a posteriorly migrated PEEK cage compressing the L5 and S1 nerves on the left; there appeared to be fusion bone across the disk space (
Discussion
The goal of endoscopic decompression is the same as open decompression, yet the minimally invasive nature of the technique allows minimal blood loss and enables quick recovery. The minimally invasive nature of fully endoscopic techniques can allow for focused neural decompression that reduces the morbidity associated with revision fusion surgery. Transforaminal endoscopic decompression for treating posteriorly a migrated PEEK TLIF cage takes advantage of a virgin corridor to the Kambin triangle
CRediT authorship contribution statement
Albert E. Telfeian: Conceptualization, Methodology, Software, Validation, Formal analysis, Investigation, Resources, Data curation, Writing - review & editing, Visualization, Supervision, Project administration. Adetokunbo Oyelese: Methodology, Validation, Formal analysis, Investigation, Resources, Writing - review & editing, Visualization. Jared Fridley: Methodology, Validation, Formal analysis, Investigation, Resources, Writing - review & editing, Visualization. Ziya L. Gokaslan: Methodology,
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Conflict of interest statement: The authors declare that the article content was composed in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.