Full-Endoscopic Removal of Migrated and Pseudoarthrotic Lumbar Interbody Cages: Case Reports and Technical Note

Int J Spine Surg. 2023 Jun;17(3):370-379. doi: 10.14444/8451. Epub 2023 May 1.


Background: The removal of a lumbar interbody cage in revision spine surgery can be challenging, as there is an increased risk of nerve injury and a protracted outcome. The aim of this study was to evaluate the feasibility and preliminary results of uniportal full-endoscopic surgery for the removal of migrated and/or pseudarthrotic lumbar interbody cages.

Methods: Three complex revision surgery cases with migrated and pseudarthrotic lumbar interbody cages are presented, and the endoscopic surgical technique is described. The clinical outcome was assessed with a visual analog scale and Oswestry Disability Index (ODI) at 1-, 3-, 6-, and 12-month follow-up, while the radiologic outcome was assessed with pre- and postoperative x-ray and computed tomographic images. Full-endoscopic surgery was performed to extract the interbody cage, bypassing scar tissue of previous surgeries with the trans-Kambin approach. Foraminoplasty with manual reamers and/or a high-speed burr under direct endoscopic vision was performed to ensure the safety of the exiting nerve root during cage extraction. The retrieved cage was replaced with a large footprint, expandable titanium cage using the trans-Kambin approach.

Results: In all 3 cases, different types of interbody cages (1 titanium, 2 polyetheretherketone, and 1 expandable titanium cage) were removed under direct endoscopic view. In 1 case, we were only able to partially remove an impacted polyetheretherketone cage from the interbody disc endoscopically. The postoperative outcome significantly (P < 0.05) improved compared with preoperative scores in all 3 cases with a follow-up of 6 and 12 months, respectively.

Conclusion: In most cases, lumbar interbody cages can be safely removed with endoscopic surgery with good preliminary clinical outcome. Nonetheless, further clinical research with long-term follow-up is required.

Clinical relevance: Results indicate the feasibility of full-endoscopic removal of migrated and pseudoarthrotic lumbar interbody cages.

Keywords: endoscopic surgery; migrated interbody cage; pseudarthrosis; revision spine surgery; trans-Kambin fusion; transforaminal approach.