Mimickers in Spine: Migrated Cages Causing Radiculopathy

Abstract

The procedure of interbody fusion has become an established treatment for many spine disorders. This arthrodesis can be achieved by hardware (fusion cage) through many approaches. Initially, posterior lumbar interbody fusion was popularized but had some serious neurological complications related to insertion as well as the migration of the cage. Gradually, transforaminal lumbar interbody fusion (TLIF) was introduced, which proved safer as it involves minimal cord handling, and also migration, if any, remains asymptomatic. We had two patients who were operated for interbody fusion using TLIF technique with subsequent posterior migration of the banana-shaped fusion cage 4–6 month after the index surgery. Both patients presented with radiculopathy mimicking a prolapsed intervertebral disc. These were evaluated and operated with the removal of the migrated cages and revision with bigger-size cages with adequate bone grafting. At the 1-year follow-up, both had remission of symptoms, and radiographs showed no subsequent migration. TLIF procedure is an established procedure to achieve arthrodesis in varying spine disorders with promising result. However, there are only a few reports describing cage migration after the procedure and these have been asymptomatic. Revision surgery is contemplated in the setting of neurological compression or instability. A bigger fusion cage in a compressive mode with adequate bone grafting is used to achieve arthrodesis. The principles of interbody fusion must be followed, and utmost precautions must be taken to prevent this unfortunate complication.