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Asian Spine J > Volume 16(2); 2022 > Article
Rawat and Kumar: Letter to the Editor: Risk Factors Affecting Cage Retropulsion into the Spinal Canal Following Posterior Lumbar Interbody Fusion: Association with Diffuse Idiopathic Skeletal Hyperostosis
Dear Editor,
We read with great interest the recent study by Kato et al. [1] assessing the risk factors affecting cage retropulsion into the spinal canal following posterior lumbar interbody fusion: association with diffuse idiopathic skeletal hyperostosis. We appreciate the author’s efforts to highlight complications on this crucial topic. However, we wish to put our few queries and want to know the author’s input, so that message from this study is presented with greater clarity.
  • 1. Did the location of cages (anterior/posterior) and undersized/lesser height cages have any effect in your study on cage retropulsion as reported by other authors [2]?

  • 2. Does the rod system used in the study was titanium or polyether ether ketone? What is the author’s recommendation from these two and does it have any effect on outcome [3]?

  • 3. What was the status of interbody fusion after single or double cage, did the number of cages alter the time and quality of fusion, and did the delayed fusion also contribute to delayed retropulsion?

  • 4. Do the authors suggest using a double cage even in poor overall condition patients, as a single cage was associated with more incidences of retropulsion in this study [4]?

  • 5. The same size cage was used in this study at the time of revision surgery. Does the use of a bigger size cage make any difference, as suggested by a few authors [2]?

Conflicts of interest

No potential conflict of interest relevant to this article was reported.

References

1. Kato S, Terada N, Niwa O, Yamada M. Risk factors affecting cage retropulsion into the spinal canal following posterior lumbar interbody fusion: association with diffuse idiopathic skeletal hyperostosis. Asian Spine J 2021 15:840–8.
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2. Hu YH, Niu CC, Hsieh MK, Tsai TT, Chen WJ, Lai PL. Cage positioning as a risk factor for posterior cage migration following transforaminal lumbar interbody fusion: an analysis of 953 cases. BMC Musculoskelet Disord 2019 20:260.
crossref pmid pmc pdf
3. Hirt D, Prentice HA, Harris JE, et al. Do PEEK rods for posterior instrumented fusion in the lumbar spine reduce the risk of adjacent segment disease? Int J Spine Surg 2021 15:251–8.
crossref pmid pmc
4. Aoki Y, Yamagata M, Nakajima F, Ikeda Y, Takahashi K. Posterior migration of fusion cages in degenerative lumbar disease treated with transforaminal lumbar interbody fusion: a report of three patients. Spine (Phila Pa 1976) 2009 34:E54–8.
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