[Duckgirl]

#27101

Hello,
I had a PLIF of L5-S1 with a PEEK cage. After months of worse radicals pain, I sought a second opinion. The 2nd surgeon told me that 1/2 the cage was in the nerve area – either it wasn’t put in far enough, or it backed out. He suggested shaving down the portion of the cage that was impinging the nerves. He couldn’t remove the cage, as the level had fused partially.

Questions – have you done something like this – or read about it? If he did shave down the cage, would the back end of the metallic markers be removed? I had the revision, and he said he did shave down my cage with an electric drill. I went and got another opinion – and the surgeon doesn’t believe he did anything with the cage as the markers are still in the same position as they were pre-op. Thank you!

[Duckgirl]

#27102

I meant to type worse radicular pain.

[Donald Corenman, MD, DC]

#27120

The general solution to a protruding cage is to remove and replace it if it is not fused in and to trim it down if it is fused and protruding. The cage is made of plastic and is relatedly easily removable once it is exposed. The exposure is the tricky part with the use of an operating microscope absolutely necessary and patience to carefully separate the nerve from the scar and the cage.

Yes I unfortunately have performed this operation many times as I seem to have a reputation for repair of surgical failures. If the metal bead implanted in the PEEK cage is still showing on X-ray protruding into the canal, more likely than not this cage is still compressing the nerve root. The next step is a CT scan of this limited area (you don’t need your entire lumbar spine scanned but only this L5-S1 level). This scan will demonstrate where the cage is and if there is or is not a solid fusion.

Dr. Corenman

PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.
 
Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.

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