J Neurol Surg A Cent Eur Neurosurg 2015; 76(02): 168-171
DOI: 10.1055/s-0034-1389095
Case Report
Georg Thieme Verlag KG Stuttgart · New York

Anterior Extrusion of Fusion Cage in Posttraumatic Cervical Disk Disease

Aymeric Amelot
1   Department of Neurosurgery, Hôpital Lariboisière, Paris, France
Schahrazed Bouazza
1   Department of Neurosurgery, Hôpital Lariboisière, Paris, France
Bernard George
1   Department of Neurosurgery, Hôpital Lariboisière, Paris, France
Mikael Orabi
1   Department of Neurosurgery, Hôpital Lariboisière, Paris, France
Damien Bresson
1   Department of Neurosurgery, Hôpital Lariboisière, Paris, France
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12. Oktober 2013

21. Mai 2014

12. Oktober 2014 (online)


Anterior interbody fusion of the cervical spine (ACDF) with bone grafts or cages has become the gold standard for treating cervical disk disease. Several technical modifications have been developed, but currently no consensus exists regarding the optimal technique. In addition, there is also evidence that complications are frequently associated with this procedure. A frequent cause for implant failure in monosegmental ACDF is cage migration into the vertebral end plates or the spinal canal. We report a patient admitted for sudden quadriparesis with complete motor deficit caused by posttraumatic cervical disk protrusion at C4–C5, resulting in spinal compression. ACDF using a titanium stand-alone cage was performed and cured the patient. At the 1-year follow-up visit, imaging showed asymptomatic anterior complete extrusion of the cage out of the disk space. To our knowledge, such an anterior cage migration without trauma has not been reported in the literature to date, and we tried to find technical reasons to explain this complication.

  • References

  • 1 Barsa P, Suchomel P. Factors affecting sagittal malalignment due to cage subsidence in standalone cage assisted anterior cervical fusion. Eur Spine J 2007; 16 (9) 1395-1400
  • 2 Hacker RJ, Cauthen JC, Gilbert TJ, Griffith SL. A prospective randomized multicenter clinical evaluation of an anterior cervical fusion cage. Spine 2000; 25 (20) 2646-2654 ; discussion 2655
  • 3 Schmieder K, Wolzik-Grossmann M, Pechlivanis I, Engelhardt M, Scholz M, Harders A. Subsidence of the wing titanium cage after anterior cervical interbody fusion: 2-year follow-up study. J Neurosurg Spine 2006; 4 (6) 447-453
  • 4 Chen L, Yang H, Tang T. Cage migration in spondylolisthesis treated with posterior lumbar interbody fusion using BAK cages. Spine 2005; 30 (19) 2171-2175
  • 5 Elias WJ, Simmons NE, Kaptain GJ, Chadduck JB, Whitehill R. Complications of posterior lumbar interbody fusion when using a titanium threaded cage device. J Neurosurg 2000; 93 (1, Suppl): 45-52
  • 6 Labrom RD, Tan JS, Reilly CW, Tredwell SJ, Fisher CG, Oxland TR. The effect of interbody cage positioning on lumbosacral vertebral endplate failure in compression. Spine 2005; 30 (19) E556-E561
  • 7 Kim S, Lee SH, Kim ES, Eoh W. Clinical and radiographic analysis of C5 palsy after anterior cervical decompression and fusion for cervical degenerative disease. J Spinal Disord Tech 2012;
  • 8 Botelho RV, Dos Santos Buscariolli Y, de Barros Vasconcelos Fernandes Serra MV, Bellini MN, Bernardo WM. The choice of the best surgery after single level anterior cervical spine discectomy: a systematic review. Open Orthop J 2012; 6: 121-128
  • 9 Hida K, Iwasaki Y, Yano S, Akino M, Seki T. Long-term follow-up results in patients with cervical disk disease treated by cervical anterior fusion using titanium cage implants. Neurol Med Chir (Tokyo) 2008; 48 (10) 440-446 ; discussion 446
  • 10 Yamagata T, Takami T, Uda T , et al. Outcomes of contemporary use of rectangular titanium stand-alone cages in anterior cervical discectomy and fusion: cage subsidence and cervical alignment. J Clin Neurosci 2012; 19 (12) 1673-1678
  • 11 Aoki Y, Yamagata M, Nakajima F, Ikeda Y, Takahashi K. Posterior migration of fusion cages in degenerative lumbar disease treated with transforaminal lumbar interbody fusion: a report of three patients. Spine 2009; 34 (1) E54-E58
  • 12 Bärlocher CB, Barth A, Krauss JK, Binggeli R, Seiler RW. Comparative evaluation of microdiscectomy only, autograft fusion, polymethylmethacrylate interposition, and threaded titanium cage fusion for treatment of single-level cervical disc disease: a prospective randomized study in 125 patients. Neurosurg Focus 2002; 12 (1) E4
  • 13 Hou TS, Tu KY, Xu YK, Zhang WM, Wang HC, Wang DL. Effect of partial discectomy on the stability of the lumbar spine. A study of kinematics. Chin Med J (Engl) 1990; 103 (5) 396-399
  • 14 Fujibayashi S, Neo M, Nakamura T. Stand-alone interbody cage versus anterior cervical plate for treatment of cervical disc herniation: sequential changes in cage subsidence. J Clin Neurosci 2008; 15 (9) 1017-1022
  • 15 Lee CH, Hyun SJ, Kim MJ , et al. Comparative analysis of 3 different construct systems for single-level anterior cervical discectomy and fusion: stand-alone cage, iliac graft plus plate augmentation, and cage plus plating. J Spinal Disord Tech 2013; 26 (2) 112-118
  • 16 Park JB, Watthanaaphisit T, Riew KD. Timing of development of adjacent-level ossification after anterior cervical arthrodesis with plates. Spine J 2007; 7 (6) 633-636
  • 17 Arrington ED, Smith WJ, Chambers HG, Bucknell AL, Davino NA. Complications of iliac crest bone graft harvesting. Clin Orthop Relat Res 1996; (329) 300-309
  • 18 Silber JS, Anderson DG, Daffner SD , et al. Donor site morbidity after anterior iliac crest bone harvest for single-level anterior cervical discectomy and fusion. Spine 2003; 28 (2) 134-139
  • 19 Lanman TH, Hopkins TJ. Early findings in a pilot study of anterior cervical interbody fusion in which recombinant human bone morphogenetic protein-2 was used with poly(L-lactide-co-D,L-lactide) bioabsorbable implants. Neurosurg Focus 2004; 16 (3) E6