Published: 2021-02-23

Iliac vein injury after anterior transforaminal lumbar interbody fusion cage migration

Catarina Aleixo, Ricardo Santos Pereira, Henrique Sousa, Pedro Seabra, José Marinhas, Filipe Lima Santos


Transforaminal lumbar interbody fusion (TLIF) is an effective treatment for many spine conditions. Anterior cage migration is one of the known complications and major vessels injury after that is a rare but potentially disastrous complication. We present a case of a 65-year-old female patient who underwent a TLIF for the treatment of an instable low grade spondylolisthesis. During the procedure, anterior dislodgment of the cage was verified and it was not possible to retrieve it by this approach. Has no bleeding or change in hemodynamical status was verified, it was decided not to proceed to removal at that moment. A CT-scan was performed and showed the position of the cage migrated through the posterior wall of the confluence of the left internal and external iliac veins. A new surgery was performed by an anterior approach to remove the cage and repair the vessel injury, by a vascular surgeon. In this case, cage migration occurred mostly because of implant malfunction. Surgeons must be aware that anterior cage migration can cause vascular injuries, and removal of this implants is effective by an anterior approach but a vascular surgeon must be part of the team.


TLIF, Iliac vein injury, Cage migration, Great vessels injury, Spine surgery

Full Text:



Zhao FD, Yang W, Shan Z, Wang J, Chen HX, Hong ZH et al. Cage migration after transforaminal lumbar interbody fusion and factors related to it. Orthop Surg. 2012;4(4):227-32.

Murase S, Oshima Y, Takeshita Y, Miyoshi K, Soma K, Kawamura N et al. Anterior cage dislodgement in posterior lumbar interbody fusion: a review of 12 patients. J Neurosurg Spine. 2017;27(1):48-55.

Ariyoshi D, Sano S, Kawamura N. Inferior vena cava injury caused by an anteriorly migrated cage resulting in ligation: case report. J Neurosurg Spine. 2016;24(3):409-12.

Bingol H, Cingoz F, Yilmaz AT, Yasar M, Tatar H. Vascular complications related to lumbar disc surgery. J Neurosurg. 2004;100(3 Suppl Spine):249-53.

Papadoulas S, Konstantinou D, Kourea HP, Kritikos N, Haftouras N, Tsolakis JA. Vascular injury complicating lumbar disc surgery. A systematic review. Eur J Vasc Endovasc Surg. 2002;24(3):189-95.

Oh HS, Lee SH, Hong SW. Anterior dislodgement of a fusion cage after transforaminal lumbar interbody fusion for the treatment of isthmic spondylolisthesis. J Korean Neurosurg Soc. 2013;54(2):128-31.

Pawar UM, Kundnani V, Nene A. Major vessel injury with cage migration: surgical complication in a case of spondylodiscitis. Spine (Phila Pa 1976). 2010;35(14):E663-6.

Ceylan D, Yaldiz C, Asil K, Kaçira T, Tatarli N, Can A. Intraoperative antepulsion of a posterior lumbar interbody fusion cage: three case reports. Pan Afr Med J. 2015;20:342.

Jin L, Chen Z, Jiang C, Cao Y, Feng Z, Jiang X. Cage migration after unilateral instrumented transforaminal lumbar interbody fusion and associated risk factors: a modified measurement method. J Int Med Res. 2020;48(2):300060519867828.

Proubasta IR, Vallvé EQ, Aguilar LF, Villanueva CL, Iglesias JJ. Intraoperative antepulsion of a fusion cage in posterior lumbar interbody fusion: a case report and review of the literature. Spine (Phila Pa 1976). 2002;27(17):E399-402. d

Heary RF, Mummaneni PV. Editorial: Vascular injury during spinal procedures. J Neurosurg Spine. 2016;24(3):407-8.