Stand-alone LLIF lateral cage migration: A case report
Wendy Towers and Khalid Kurtom report on a rare case of a stand-alone lateral cage migration
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 demineralised 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.
Introduction
The minimally invasive transpsoas lateral lumbar interbody fusion (LLIF) was first described by Ozgur, et al. [1] in 2006. Since then, it has become a valuable option for patients with degenerative disc disease, spondylolisthesis, foraminal stenosis, tumor, and trauma [1–4]. Stand-alone LLIF is a minimally invasive transpsoas approach to achieve indirect decompression of the neural elements while restoring disc height and spinal alignment without other fixation measures, such as pedicle screws or lateral plate. The LLIF permits thorough disc removal and preparation of the graft bed. Indirect decompression is achieved by laterally placing an interbody graft of polyetheretherketone (PEEK) while maintaining biomechanical ligamental structures, namely the anterior longitudinal ligament and annulus, both restricting motion [1]. The implant also spans the apophyseal ring, which avoids cancellous bone and therefore, in theory, inhibits subsidence [5–6].
While avoiding major complic