PMC6079598_01
Preoperative MRI of lumbosacral spine T1W image showed prepsoas corridor at the level of intervertebral disc space L4-L5 (a and b) and at the level of upper vertebral body of L5 (c and d). Rising of psoas muscle was shown in (d). Left common iliac artery almost obliterates prepsoas space at level of upper vertebral body of L5 (black asterisk).
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fig1
On the axial T1W image, the space between the left common iliac artery and the left psoas muscle was 18.98 mm at level of intervertebral disc space L4-L5 which almost obliterated prepsoas space at level of upper vertebral body of L5 (Figure 1). This could be explained because the left common iliac artery was close to the edge of left psoas muscle as Figure 1.
Postoperative plain films of lumbar spine AP and lateral (a and b) showed the MIS-OLIF PEEK cage was placed too deep over edge of right lateral of vertebral body.
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fig2
Plain films showed the position of MIS-OLIF PEEK cage was placed too deep over the edge of the right lateral vertebral body (Figure 2).
Model picture showed the possibility that MIS-OLIF PEEK cage locked with the vertebral endplates.
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fig3
The MIS-OLIF PEEK cage teeth might have locked with the right lateral end plates of vertebral bodies (Figure 3).
Drawing picture showed the reverse jack-knife position of the patient with distraction of retractor blade pins for loosening the MIS-OLIF PEEK cage form the vertebral endplates.
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fig4
Retractor blade pins at L4 and L5 vertebral bodies were gradually distracted (Figure 4).
Three months postoperative plain films of lumbar spine AP and lateral (a and b) showed the acceptable position of MIS-OLIF PEEK cage.
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fig5
The MIS-OLIF PEEK cage then was gently pulled back and adjusted to a more anterior trajectory to achieve an acceptable position (Figure 5).