Publication:

Iliac vein injury after anterior transforaminal lumbar interbody fusion cage migration

Transforaminal lumbar interbody fusion (TLIF) is an effective treatment for many spine conditions. Anterior cage migration is one of the known complications and major vessels injury after that is a rare but potentially disastrous complication. We present a case of a 65-year-old female patient who underwent a TLIF for the treatment of an instable low grade spondylolisthesis. During the procedure, anterior dislodgment of the cage was verified and it was not possible to retrieve it by this approach. Has no bleeding or change in hemodynamical status was verified, it was decided not to proceed to removal at that moment. A CT-scan was performed and showed the position of the cage migrated through the posterior wall of the confluence of the left internal and external iliac veins. A new surgery was performed by an anterior approach to remove the cage and repair the vessel injury, by a vascular surgeon. In this case, cage migration occurred mostly because of implant malfunction. Surgeons must be aware that anterior cage migration can cause vascular injuries, and removal of this implants is effective by an anterior approach but a vascular surgeon must be part of the team.