Journal of Craniovertebral Junction and Spine (May 2024)

Transdural retrieval of retropulsed transforaminal lumbar interbody fusion cages

  • Devon Lefever,
  • Jean-Christophe Leveque,
  • Thomas Allen Hanks,
  • Rajiv K. Sethi,
  • Nicholas C. Eley

DOI
https://doi.org/10.4103/jcvjs.jcvjs_29_24
Journal volume & issue
Vol. 15, no. 2
pp. 258 – 261

Abstract

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Transforaminal lumbar interbody fusions (TLIFs) are performed for various lumbar spine pathologies. Posterior migration of an interbody cage is a complication that may result in neurologic injury and require reoperation. Sparse information exists regarding the safety and efficacy of a transdural approach for cage retrieval. We describe a surgical technique, in which centrally retropulsed cages were safely retrieved transdurally. A patient with prior L3-S1 posterior lumbar fusion and L4-S1 TLIFs presented with radiculopathy and weakness in dorsiflexion. Imaging revealed posterior central migration of TLIF cages causing compression of the traversing L5 nerve root. Cages were removed transdurally; the correction was performed with an all-posterior T10-pelvis fusion. Aside from temporary weakness in right-sided dorsiflexion, the patient experienced complete resolution in their radiculopathy and strength returned to its presurgical state by 3 months. The transdural approach for interbody removal can be safely performed and should be a tool in the spine surgeon’s armamentarium.

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