TLIF Cage Migration Causing Cauda Equina Syndrome: A Case Report

Abstract

Study Design: Case report Objectives: To present a rare case of cauda equina syndrome caused by early posterior cage migration after transforaminal lumbar interbody fusion (TLIF). Summary of Literature Review: TLIF is widely used to treat degenerative lumbar spine disease. The procedure aims to restore disc height, provide anterior column support, improve spinal stability, and decompress the neuroforaminal space. Despite these advantages, complications such as cage migration, dural injury, and pseudoarthrosis may occur. Materials and Methods: A 54-year-old woman presented with low back and leg pain, bilateral ankle dorsiflexion weakness (2/5), perianal sensory deficit, and urinary and fecal incontinence. She had undergone TLIF at another center two weeks earlier. Lumbar magnetic resonance imaging showed spinal stenosis at L2–3, L3–4, and L4–5, with severe compression at L4–5 due to cage migration. Results: Emergency surgery was performed. Bilateral transpedicular instrumentation was applied from L2 to L5, followed by total laminectomy, flavectomy, and bilateral foraminotomy at L2–3, L3–4, and L4–5. The migrated L4–5 cage was successfully removed without complications. Postoperatively, motor deficits and sensory loss improved, but urinary and fecal incontinence persisted. Conclusions: Early postoperative cage migration should be considered when neurological deterioration occurs after TLIF. Careful patient selection and meticulous surgical technique are essential to minimize this complication. © 2026 Korean Society of Spine Surgery.