Aoki Yasuchika, Yamagata Masatsune, Nakajima Fumitake, Ikeda Yoshikazu, Takahashi Kazuhisa
Department of Orthopedic Surgery, Chiba Rosai Hospital, 2-16 Tatsumidai-higashi, Ichihara, Chiba, Japan.
Spine (Phila Pa 1976). 2009 Jan 1;34(1):E54-8. doi: 10.1097/BRS.0b013e3181918aae.
A case report of 3 patients with posterior migration of bullet-shaped fusion cages after transforaminal lumbar interbody fusion (TLIF). One patient required emergency revision surgery; the other 2 patients are being observed during conservative treatment.
To review cases of posterior migration of fusion cages and report ensuing clinical courses.
TLIF is a commonly used procedure; however, there are few reports describing cage migration after the procedure. In most cases, when posterior cage migration follows posterior lumbar interbody fusion, emergency revision surgery is required. One recent study reported a case of posterior cage migration after TLIF, which was treated conservatively.
Posterior migration of the bullet-shaped fusion cages occurred 1 to 2 months after TLIF in 3 patients. One of the 3 patients had isthmic spondylolisthesis treated by TLIF with bilateral pedicle screw fixation. The other 2 patients had degenerative scoliosis and were treated by TLIF with unilateral pedicle screw fixation.
The patient with isthmic spondylolisthesis required revision surgery because the migrated cage caused nerve root irritation. The migrated cage was removed and a large-sized cage was employed to achieve stability. The other 2 patients had no pathologic symptoms after the posterior migration of the cage and were treated conservatively and observed.
Revision surgery after TLIF appears relatively safe because the migrated cage tends to locate more laterally than in patients with cage migration after posterior lumbar interbody fusion. Cage migration subsequent to TLIF may not cause compression of neural tissues, so conservative treatment may suffice for these patients. Unilateral pedicle screw fixation may not provide sufficient stability to prevent cage migration in patients with degenerative scoliosis. Further study is needed to clarify surgical indications for unilateral pedicle screw fixation in TLIF.
3例经椎间孔腰椎椎体间融合术（TLIF）后子弹形融合器向后移位患者的病例报告。1例患者需要急诊翻修手术；另外2例患者在保守治疗期间接受观察。
回顾融合器向后移位的病例并报告后续临床过程。
TLIF是一种常用手术；然而，很少有报告描述该手术后融合器移位情况。在大多数情况下，腰椎后路椎体间融合术后出现融合器向后移位时，需要急诊翻修手术。最近一项研究报告了1例TLIF术后融合器向后移位的病例，该病例接受了保守治疗。
3例患者在TLIF术后1至2个月出现子弹形融合器向后移位。3例患者中的1例患有峡部裂性腰椎滑脱，接受了TLIF联合双侧椎弓根螺钉内固定治疗。另外2例患者患有退行性脊柱侧凸，接受了TLIF联合单侧椎弓根螺钉内固定治疗。
峡部裂性腰椎滑脱患者需要进行翻修手术，因为移位的融合器导致神经根刺激。取出移位的融合器并使用大型融合器以实现稳定。另外2例患者在融合器向后移位后没有出现病理性症状，接受了保守治疗并进行观察。
TLIF术后翻修手术似乎相对安全，因为移位的融合器往往比腰椎后路椎体间融合术后融合器移位的患者更偏向外侧定位。TLIF术后融合器移位可能不会导致神经组织受压，因此这些患者采用保守治疗可能就足够了。单侧椎弓根螺钉内固定可能无法为患有退行性脊柱侧凸的患者提供足够的稳定性以防止融合器移位。需要进一步研究以明确TLIF中单侧椎弓根螺钉内固定的手术适应证。
