Chen Liang, Yang Huilin, Tang Tiansi
Department of Orthopaedic Surgery, First Affiliated Hospital of Suzhou University, Suzhou, PRC.
Spine (Phila Pa 1976). 2005 Oct 1;30(19):2171-5. doi: 10.1097/01.brs.0000180402.50500.5b.
A retrospective study was conducted to review the complication of cage migration in posterior lumbar interbody fusion (PLIF) with the Bagby and Kuslich method.
To review and analyze cage migration in spondylolytic spondylolisthesis treated with PLIF using paired BAK cages.
PLIF with cages has been introduced to treat spondylolisthesis for several years. Theoretically, this technique offers several advantages. BAK system gained popularity rapidly in recent few years. However, most reports focused on clinical effects; only a few studies had been carried out to review complications. As one of the major complications, cage migration into vertebral body or spinal canal may result in severe or disastrous consequence, only a few reports discussed on this issue.
From October 1997 to August 2000, 118 patients with spondylolytic spondylolisthesis underwent single-level PLIF using paired BAK cages filled with morselized autogenous bone; 88 of them were followed up for more than 2 years with an average of 3 years and 10 months. The complication of cage migration and its sequelae were reviewed.
Three cases of cage retropulsion and four cases of cage subsidence were found in the current study. The rate of cage migration in patients with no posterior instrumentation was significantly higher compared with that rate in those with posterior instrumentation (16.7% vs. 0%). For patients with no posterior instrumentation, 4 of 8 cases with total facetectomy and 3 of 34 cases with partial facetectomy developed cage migration; the rate of cage migration was 16% for patients with preoperative Grade I olisthesis and 17.6% for those with preoperative Grade II olisthesis (P > 0.05). All patients with cage subsidence lost some degree of lumbar lordosis and disc height, 2 of them finally obtained suboptimal fusion, the other 2 developed pseudarthrosis and received additional posterior instrumentation and intertransverse fusion. Two patients with cage retropulsion developed severe lumbar stenosis and have to remove their dislocated cages. The other one received conservative treatment.
An 8% rate of cage migration was found in the current study, and 4 of 7 cases with cage migration received revision surgery. Several factors may contribute to the cage migration, including lack of posterior instrumentation and total facetectomy. Revision surgery for cage migration was technically challenging.
进行一项回顾性研究，以评估采用Bagby和Kuslich方法行后路腰椎椎间融合术（PLIF）时椎间融合器移位的并发症。
回顾并分析采用配对BAK椎间融合器的PLIF治疗峡部裂型腰椎滑脱症时椎间融合器的移位情况。
使用椎间融合器的PLIF治疗腰椎滑脱症已应用数年。理论上，该技术具有若干优势。BAK系统在最近几年迅速普及。然而，大多数报告聚焦于临床疗效；仅有少数研究对并发症进行了评估。作为主要并发症之一，椎间融合器向椎体或椎管内移位可能导致严重或灾难性后果，仅有少数报告讨论过此问题。
1997年10月至2000年8月，118例峡部裂型腰椎滑脱症患者接受了使用配对BAK椎间融合器并填充碎自体骨的单节段PLIF手术；其中88例随访超过2年，平均随访时间为3年10个月。对椎间融合器移位及其后遗症的并发症进行了评估。
本研究中发现3例椎间融合器后移及4例椎间融合器下沉。未行后路内固定的患者椎间融合器移位率显著高于行后路内固定的患者（16.7%对0%）。对于未行后路内固定的患者，8例全椎板切除患者中有4例、34例部分椎板切除患者中有3例发生椎间融合器移位；术前I度滑脱患者的椎间融合器移位率为16%，术前II度滑脱患者为17.6%（P>0.05）。所有椎间融合器下沉的患者均有一定程度的腰椎前凸和椎间盘高度丢失，其中2例最终融合效果欠佳，另外2例发生假关节形成并接受了额外的后路内固定和横突间融合术。2例椎间融合器后移的患者出现严重腰椎管狭窄，不得不取出移位的椎间融合器。另1例接受了保守治疗。
本研究中椎间融合器移位率为8%，7例椎间融合器移位患者中有4例接受了翻修手术。多种因素可能导致椎间融合器移位，包括缺乏后路内固定和全椎板切除。椎间融合器移位的翻修手术在技术上具有挑战性。
