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Case report
peer-reviewed

Stand-alone LLIF Lateral Cage Migration: A Case Report



Abstract

Lateral approaches to the lumbar disc space have become popular in recent years with very few reported complications. We report on a rare case of a stand-alone cage migration.

A 77-year-old female presented with a right L2-3 radiculopathy that was refractory to maximum medical management. This was secondary to foraminal compression at L2-3 and L3-4 due to degenerative disc disease and levoscoliosis, as well as Grade 1 spondylolisthesis at both levels. A left-sided approach lateral lumbar interbody fusion was performed at L2-3 and L3-4 using a lordotic polyetheretherketone (PEEK) graft (50 mm length x 18 mm width x 9 mm height) packed with demineralized bone matrix (DBM). A contralateral release of the annulus fibrosis was performed during the decompression prior to graft insertion. Postoperative anteroposterior and lateral x-ray imaging confirmed good position of interbody grafts, correction of scoliosis as well as spondylolisthesis, and restoration of disc height achieving foraminal indirect decompression. A routine postoperative x-ray at three months demonstrated asymptomatic ipsilateral cage migration at the L2-3 level with evidence of arthrodesis in the disc space. This was managed conservatively without further surgical intervention.

Placement of a lateral plate or interbody intradiscal plating system in patients with scoliosis and significant coronal deformity is an option that can be considered to prevent this rare LLIF complication. Moreover, asymptomatic cage migration may be conservatively managed without reoperation. 



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Case report
peer-reviewed

Stand-alone LLIF Lateral Cage Migration: A Case Report


Author Information

Wendy S. Towers Corresponding Author

Neurosurgery, University of Maryland Shore Regional Health

Khalid H. Kurtom

Neurosurgery, University of Maryland Shore Regional Health


Ethics Statement and Conflict of Interest Disclosures

Human subjects: Consent was obtained by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.


Case report
peer-reviewed

Stand-alone LLIF Lateral Cage Migration: A Case Report


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Case report
peer-reviewed

Stand-alone LLIF Lateral Cage Migration: A Case Report

  • Author Information
    Wendy S. Towers Corresponding Author

    Neurosurgery, University of Maryland Shore Regional Health

    Khalid H. Kurtom

    Neurosurgery, University of Maryland Shore Regional Health


    Ethics Statement and Conflict of Interest Disclosures

    Human subjects: Consent was obtained by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

    Acknowledgements


    Article Information

    Published: October 12, 2015

    DOI

    10.7759/cureus.347

    Cite this article as:

    Towers W S, Kurtom K H (October 12, 2015) Stand-alone LLIF Lateral Cage Migration: A Case Report. Cureus 7(10): e347. doi:10.7759/cureus.347

    Publication history

    Received by Cureus: March 24, 2015
    Peer review began: March 25, 2015
    Peer review concluded: September 26, 2015
    Published: October 12, 2015

    Copyright

    © Copyright 2015
    Towers et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 3.0., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

    License

    This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Abstract

Lateral approaches to the lumbar disc space have become popular in recent years with very few reported complications. We report on a rare case of a stand-alone cage migration.

A 77-year-old female presented with a right L2-3 radiculopathy that was refractory to maximum medical management. This was secondary to foraminal compression at L2-3 and L3-4 due to degenerative disc disease and levoscoliosis, as well as Grade 1 spondylolisthesis at both levels. A left-sided approach lateral lumbar interbody fusion was performed at L2-3 and L3-4 using a lordotic polyetheretherketone (PEEK) graft (50 mm length x 18 mm width x 9 mm height) packed with demineralized bone matrix (DBM). A contralateral release of the annulus fibrosis was performed during the decompression prior to graft insertion. Postoperative anteroposterior and lateral x-ray imaging confirmed good position of interbody grafts, correction of scoliosis as well as spondylolisthesis, and restoration of disc height achieving foraminal indirect decompression. A routine postoperative x-ray at three months demonstrated asymptomatic ipsilateral cage migration at the L2-3 level with evidence of arthrodesis in the disc space. This was managed conservatively without further surgical intervention.

Placement of a lateral plate or interbody intradiscal plating system in patients with scoliosis and significant coronal deformity is an option that can be considered to prevent this rare LLIF complication. Moreover, asymptomatic cage migration may be conservatively managed without reoperation. 



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