Complications of posterior lumbar interbody fusion when using a titanium threaded cage device

Object. The authors reviewed their series of patients to quantify clinical and radiographic complications in those who underwent a posterior lumbar in terbody fusion (PLIF) procedure in which a threaded interbody cage (TIG) wa s implanted. Methods. Sixty-seven patients underwent a posterior lumbar interbody fusion procedure in which a TIC was used. The authors excluded patients who under went procedures in which other instrumentation was used or a nondorsal appr oach was performed. Fifteen percent of the cases (10 patients) were complic ated by laceration of the dura. In three cases, bilateral implantation coul d not be performed. The average blood loss was 670 ml for all cases, and bl ood transfusion was required in 25% of the cases (17 patients). The rate of minor wound complication was 4.5% (three patients). One patient died. The average period of hospitalization was 4.25 days. Twenty-eight patients (42%) experienced significant low-back pain 3 months postoperatively, and in 10 (15%) of these cases it persisted beyond 1 year. In 10 patients postoperative radiculopathy was demonstrated, and magnetic resonance imaging revealed epidural fibrosis in six patients, arachnoiditis in one, and a recurrent disc herniation in one. One patient incurred a per manent motor deficit with sexual dysfunction. Pseudarthrosis was suggested radiographically with evidence of motion on lateral flexion-extension radio graphs (10 cases), lucencies around the implants (seven cases), and posteri or migration of the cage (two cases). Additional procedures (in 14 patients) consisted primarily of transverse pr ocess fusion with pedicle screw and plate augmentation for persistent back pain and radiographically demonstrated signs of spinal instability. In two patients with radiculopathy, migration of the TIC required that it be remov ed. Graft material that extruded from one implant necessitated its removal. In one patient scarectomy was performed. Conclusions. Our high incidence of TIG-related complications in PLIF is inc onsistent with that reported in previous studies.