Cauda Equina Syndrome Following Posterior Interbody Cage Migration after TLIF: A Rare Case Report

Introduction: Transforaminal lumbar interbody fusion (TLIF) is a widely accepted surgical technique for the management of degenerative lumbar spondylolisthesis. The procedure provides circumferential decompression, restoration of disc height, and segmental stabilization. Despite favorable outcomes, complications such as interbody cage migration or posterior cage back-out may occur compromise surgical success, necessitating revision surgery. Case Report: We present the case of a 45-year-old male with symptomatic degenerative L4-L5 spondylolisthesis who underwent minimally invasive TLIF (MIS-TLIF) after failure of conservative treatment. Postoperatively, the patient developed posterior migration of the interbody cage with neural compression leading to Cauda Equina syndrome. Revision MIS-LTLIF (MIS-TLIF using a large-footprint cage) was performed with removal of the migrated cage of size 9 × 22 mm and insertion of a larger footprint interbody cage of size 10 × 40 mm following meticulous bilateral disc space clearance and endplate preparation. Post-revision surgery imaging demonstrated stable implant positioning, and the patient showed significant clinical improvement without further complications. Conclusion: Interbody cage back-out following TLIF is a preventable complication. Inadequate disc space preparation and selection of a suboptimal cage footprint may significantly contribute to cage migration. Proper surgical technique and appropriate implant choice are essential to ensure construct stability and favorable clinical outcomes.