title: Set screw fracture with cage dislocation after two-level transforaminal lumbar interbody fusion (TLIF): a case report.
abstract: BACKGROUND
  Transforaminal lumbar interbody fusion is a popular procedure used to achieve spondylodesis in patients with degenerative lumbar spinal diseases. We present a rare case of a patient with a set screw fracture with cage dislocation after an open transforaminal lumbar interbody fusion procedure. To the best of our knowledge, this case is the first of its kind to be reported.
  
  
  METHODS
  A 44-year-old Caucasian woman attended a follow-up appointment at our hospital 3 months after treatment for second-degree lumbar spondylolisthesis (L4/L5) and osteochondrosis (L5/S1) with transforaminal lumbar interbody fusion and dorsal spondylodesis. She complained of severe leg pain on the left side. Her physical examination revealed a normal neurological status, except for paresthesia of the entire left lower limb and at the ball of the left foot. Radiological imaging showed breaking of the set screws with cage dislocation. Surgical revision was then performed with exchange of the whole dorsal instrumentation and the dislocated cage. Six weeks post-operatively, the patient was seen again at our clinic without neurological complaints, except for decreased sensitivity on the dorsum of her left foot. The wound healing and radiological follow-up were uneventful.
  
  
  CONCLUSIONS
  Hardware-related complications are rarely seen in patients with open transforaminal lumbar interbody fusion, but must be kept in mind and can potentially cause severe neurological deficits.
authors.affiliation: Abteilung für Orthopädie, Universitätsmedizin Göttingen, Robert-Koch-Strasse 40, 37075 Göttingen, Germany. philipleute@googlemail.com.
authors.forename: Philip Johannes Felix
authors.initials: PJ
authors.lastname: Leute
authors.forename: Ahmed
authors.initials: A
authors.lastname: Hammad
authors.forename: Isabel
authors.initials: I
authors.lastname: Hoffmann
authors.forename: Sebastian
authors.initials: S
authors.lastname: Hoppe
authors.forename: Hans-Michael
authors.initials: HM
authors.lastname: Klinger
authors.forename: Stefan
authors.initials: S
authors.lastname: Lakemeier
mesh_terms: D000328:Adult; D001863:Bone Screws; D005260:Female; D005548:Foreign-Body Migration / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery*; D011859:Radiography; D012086:Reoperation; D013123:Spinal Fusion / Q000009:adverse effects / Q000295:instrumentation*; D013168:Spondylolisthesis / Q000601:surgery*; D016896:Treatment Outcome