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Cage movement 4 mos postop ALIF L4/5

candle99ccandle99 Posts: 279
edited 06/11/2012 - 8:24 AM in Back Surgery and Neck Surgery
Has anyone had or heard of cage movement? I'm 4 mos postop from ALIF L4/L5 with threaded cages and BMP. I got into a fix this week with pain that was putting me into tears. Went back to the NS and they did bloodwork and gave me an epidural shot. Today I had an MRI but am waiting for the report. I did bring home a cdrom. I know I'm not a doctor, but it looks like one of the cages is sticking out into my spinal cord. I have a bulge at L3/L4 and my L4/L5 area looks bumped out more than L3/L4. If this is what is wrong and causing all the pain, what can they do about it? I know I'm freaking without really knowing the true story, but I can't find much on the net about cage movement. I haven't fused yet and my NS was saying he thought I was having too much movement in the joint causing the pain. But after seeing the MRI pics, I'm worried that one has migrated out of the joint space.



  • Hi Candle, I hope you are wrong. Do you have an older pic to compare it to? I believe Itsalongwalk had her cage move into the spinal canal, you might look her up. She had another operation to fix it. Do you have any hardware? Is your cage titanium? Mine is Peek,so all that shows are 2 dots that are markers for cage postion. When do you see the surgeon again to get the results? I hope soon so you don't have to keep worrying. That is exactly why I tried not to look at my xrays myself, but of course I couldn't resist either ;) Good-luck, let us know what you find out,
    >:D< Cali-Sue
  • unnecessarily. Hopefully it is just the angle of the MRI that makes it look as if it has shifted.
    Yes, curiosity gets the cat doesn't it. :))( It is so hard not to look and they are so difficult to understand. When do you see the Dr next fo give him the MRI?????

    Blessings Sara O:) (with fingers and toes crossed)

  • I wouldn't be comfortable having a fusion with only cages and no extra support from hardware. I think this is why most doctors use it. I think I've only heard from one other person on this site who had cages but no hardware.

    Hope it's nothing major.
  • You don't say if your pain is back pain or leg pain. Yes, cages can migrate. Cages can also break down. Cages can also cause an inflammatory response by the surrounding tissue that causes pain. BMP can cause bone to grow on nerve root causing return of leg pain.

    Lots of complications can happen but fortunately for most people it is usually just one of the ups and downs of postop recovery. I'm interested to hear what your doc has to say and if you improve. If no improvement and you're not happy with your doctor's investigation, you can also get a 2nd opinion.
  • Melissa,

    What you describe sounds similar to my own experience. Check out www.chirogeek.com who has a good explanation of a MRI / CT scan. It may help rest your mind.

    Yes my cage migrated into my spinal canal. I had revision surgery to remove it. It had / has inflammed my L4 nerve root. As it is nerve tisse it is slow to heal.

    My Surgeon was not happy to wait and moved quickly to sort this. It was not replaced in the end as my fusion was progressing. My pain has defo turned down on the volume but I am still in pain.

    Worry not until the NS has termined what he is going to do.
    Remain fairly sedentary in the meantime. I am sure if your worries are correct, they 'll move fairly quick.

    Take care and keep me posted.

    Cage migration from what I have read is a rare complication. There are a few papers if you type them in your search engine.
  • Okay, still waiting for the NS to call me. They were supposed to call me Friday, but didn't. I called them around 9am and she had my MRI report and the bloodwork results out for them and said she'd have the NS or his nurse to call. I sat here all day in the recliner on a heating pad, drugged, but waiting.

    I'm trying to remain calm, but I'm very anxious and the pain is very bad. It's right in the middle of my low back and is like a knife is in there, very sharp nauseating pain. If I lean back just a bit, it's worse as I come back to straight.

    Yes, I had cages only, no other hardware. I asked the NS before surgery if that would be enough to hold things together and he said yes. I have probably done too much. We have a farm and I have two kids, so after 8 weeks when I went back to work, I've been trying to do as much as possible with the laundry, housework, and all. I've worn my brace though. I have been slightly bending, altho I squat and have used the skater's stance keeping my back straight. I haven't lifted anything heavy. The only thing I can think of is that I did fall down. I was walking a horse out of the gate and he decided to bolt away. One of our dogs spooked him. I for some reason, held on to the lead rope trying to stop him I guess and I just went down and rolled on one hip. I had told my NS about this at my 3 mos. appt and he wasn't concerned.

    When I went in Wednesday, my NS said he usually ignores people's complaints up to a point, but he wanted to do the tests to make sure. I was so glad! Something just isn't right. I've tried to endure the pain, but it's just got to me.

    Thanks everyone for your info and comments. I will post again when I hear Monday what's really wrong. I hope it's nothing too but the MRI images just look really wrong where the cages are. One of the spacers is bumped out further than my L3/L4 bulged disc. I do have my MRI images from a year ago and there is a difference, where the spinal cord is white and the bumps out from the back bones from the side. I wished I could post them somewhere.

  • Your wrong but then I also hope you get an answer for th epain.

    The horse running may have jolted your body?

    I am surprised you don't have screws. You are an interbody fusion? Is your surgeon mature, older person (old school)? I wonder w he prefers this method,hmmm. :?

    One other thought on th eback of the no screws (interbody...weird) did you get a second opinion or perhaps line someone up, just in case.

    Good Luck and Chill out, get resting at least til you know whats happening!

  • Hi Candle,

    I really don't have anything to add from what the others have said I just wanted to tell you I am sorry you are in so much pain and so worried. I know how it is having new issues to be worried about. I really hope it is not as bad as you think and that your doctor can get to the bottom of your pain soon. Please let us know as soon as you find something out.


  • I called in to the NS this morning first thing and was told that I'm to come in to their office tomorrow at 1pm and they'll go over my results with me. That makes me think this is serious. I told her they said they'd call with the results and she said she was just told to tell me about the appt. ARGH!

    I did get a copy of the MRI report and it's very short, doesn't mention any other discs or problems...except my L4-5. It says "There is some indention of the anterior thecal sac at L4-5 level which results in moderate spinal canal narrowing. The rest is either a restatement of this or about the post-operative change of fusion with some metallic artifact (artifact?). The thing that bothers me is the report doesn't say what is making the indention into my spinal canal. Looks like they would say it's the metal artiface (spacer) or it was scar tissue built up or bone BMP stuff.

    Now I have to wait another day to find out my fate for another surgery or not. So far other than really bad pain, I'm not having any leg symptoms, just an occasional zip/zap or pin prick feeling, nothing to the extent I was having before surgery. I just hope this indention doesn't get worse before I know what they are going to do about it. Thank God for Lortab's is all I can say right now.

  • artifact is a term they radiologists use for saying that the metal rods and screws are in the way and they cant see clearly enough to give a definite picture.
    Frustrating I know as I just had an MRI also which pretty much only mentionded artifact.

    Most specalist Drs do not rely on the report but read the films themselves. I know my doc doesn't even look at the report.

    Hope things go well for you and this is just a small hiccup
    Blessings Sara O:)

  • You may need a CT to show the bone and metal work more clearly but i know metal is distorted in these films.

    Good luck tomoroow. >:D<
  • Just curious how it went. I hope you are doing well!

  • My NS looked at the MRI and said "well you have a bump into the canal, but that's okay". My jaw dropped out. He said he wanted to do a myelogram and CT scan to see if that bump or the moved cage was pressing on any nerve roots. He thinks my pain is from all the movement since I have no fusion yet. He said the bump was not the cage, but could be disc material that he left in the back to hold the cages and the moved cage has shoved that material out. I thought that would still not be a good thing??? He said I wasn't in danger of being paralyzed or anything since your spinal cord really ends at L1, the rest from L2 down are the rest of the nerves that control body functions and leg pain.

    I went over to the hospital and had another myelogram and CT (I'd had this plus a discogram in June before my initial ALIF fusion surgery). We got in at 8pm and I still had to keep my head up until midnight to keep the dye down.

    He said I had two choices...to just let it go for 6 more months and see if it'll fuse. It's already been 4 and nothing. Or, he would go in posteriorly and put in screws and lock down the joints so that it would feel like it was fused right then and take off the bump that was showing and anything else that shows in the myelogram/CT (decompression).

    At this point, I'm going to opt for the additional surgery to get the posterior screws. I'm tired of hurting and think that's the best route for me. I'm out of leave at work, but can survive on leave without pay for another 12 weeks. My insurance max is met for the year, so I won't have a huge bill again to pay.

    I'm supposed to call him this afternoon to get the results from the myelogram/CT and discuss what to do. He's the kind of doctor that won't ever tell you what to do. He's dry but not rude. I trusted that the cages would work without extra hardware, but they aren't. I have too much play in my joints and loose in muscles, even with wearing the back brace for 3 weeks again, the pain has increased.

    Thanks you guys for your comments and posts. I'm so glad to have this site and my spiney friends for support. You all know what anxieties and what the pain is like. I've hurt for so long, I'm not sure anymore what it would be like to not hurt. I don't want more surgery, but I want to recover.

    I'll post when I get my results this afternoon.
  • Candle, I am sorry it wasn't better news, but maybe now you can get something done to help you get better. I thought they removed all of the disc, but maybe not when they do it without hardware. Let us know what the plan is after you get your results. Take care, >:D< Cali-Sue
  • I guess from what I've heard they generally DO leave a small portion of the disc with fusions. They call it a radical discectomy when they remove every spec of it. Thankfully my surgeon did, but it was only because I herniated twice in the same disc.

    Yikes, candle. That sucks :( But honestly, the more stability you have the better. I can't imagine not having hardware. But I'm also 22 with ADHD, and there is no way in hell I can sit around all day... I am constantly doing things I probably shouldn't be, so my hardware has probably saved my back Lol.

    My surgeon uses plastic cages for that reasons... So it doesn't block anything and you have a perfectly clear view of the x-ray. Pretty sweet idea, in my opinion. I was 100 percent ALL for the plastic cages. Haha.
  • I'm scheduled for the posterior part on 12/4. The CT/myelogram report states there is questionable contact with the L5 nerve roots bilaterally, without obvious compression. Questionable is enough for me to want this fixed! My right leg and foot buzz after I sit for a bit or stand for any period of time. That's enough to let me know it's not questionable.

    The NS is going to do posterior instrumentation and decompression. I'm so hoping that this surgery will be the same or better recovery time as the ALIF? It's a bummer to have to go back to the raised potty seat and arms and the grabber again!

    Wish me luck this time that I get fixed!
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