title: Intraoperative antepulsion of a fusion cage in posterior lumbar interbody fusion: a case report and review of the literature.
abstract: METHODS
  A case of intraoperative anterior migration into the abdominal cavity of a titanium fusion cage in the course of posterior lumbar interbody fusion.
  
  
  OBJECTIVE
  To explain the importance of a proper introduction of the fusion cages in the vertebral space and the necessity of intraoperative fluoroscopy study in both planes, frontal and lateral, respectively, to confirm the proper position of the implants. A potential serious complication of fusion cage instrumentation and the limited literature on this subject are reviewed.
  
  
  BACKGROUND
  Early reports regarding fusion cage instrumentation have been encouraging. However, the potential benefits are better defined than the potential complications.
  
  
  METHODS
  A patient had anterior migration of a fusion cage intraoperatively in the course of posterior lumbar interbody fusion. One day later, the patient underwent surgical laparotomy to extract the migrated implant and a repeat posterior procedure that included bilateral posterior fusion with insertion of pedicle instrumentation.
  
  
  RESULTS
  One year after the second operation, the patient remains pain-free, and no abdominal lesions or neurologic deficits were observed.
  
  
  CONCLUSIONS
  The various types of spinal fusion operations are associated with specific complications. A through knowledge of the procedures and possible complications, as well as meticulous surgical technique, can help minimize these. Once complications do occur, prompt recognition and treatment should minimize the long-term sequelae.
authors.affiliation: Centro Medico Lenox, Barcelona, Spain. iproubasta@hsp.santpau.es
authors.forename: Ignacio R
authors.initials: IR
authors.lastname: Proubasta
authors.forename: Enrique Q
authors.initials: EQ
authors.lastname: Vallvé
authors.forename: Luis F
authors.initials: LF
authors.lastname: Aguilar
authors.forename: Carlos L
authors.initials: CL
authors.lastname: Villanueva
authors.forename: José J D
authors.initials: JJ
authors.lastname: Iglesias
mesh_terms: D000328:Adult; D005260:Female; D005548:Foreign-Body Migration / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000175:diagnosis / Q000601:surgery*; D007431:Intraoperative Complications / Q000209:etiology*; D008161:Lumbosacral Region; D008279:Magnetic Resonance Imaging; D019736:Prostheses and Implants / Q000009:adverse effects*; D012086:Reoperation; D013123:Spinal Fusion / Q000009:adverse effects* / Q000295:instrumentation; D014025:Titanium / Q000009:adverse effects; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D014025:Titanium