Comparative Study of Cage Subsidence in Single-Level Lateral Lumbar Interbody Fusion

Hiyama, Akihiko; Sakai, Daisuke; Katoh, Hiroyuki; Nomura, Satoshi; Sato, Masato; Watanabe, Masahiko

doi:10.3390/jcm11051374

Cited by 21 publications

(10 citation statements)

References 43 publications

(53 reference statements)

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“…Therefore, this score is not a good predictor for cage subsidence in OLIF surgery and demonstrates low accuracy (0.695). Previous studies have reported that Hounsfield units calculated by qCT may help assess bone quality more accurately than the DEXA T-score [ 9 , 34 ]. Notably, low Hounsfield units indicate low BMD, which further indicates a higher incidence of developing cage subsidence [ 7 , 35 ].…”

Section: Discussionmentioning

confidence: 99%

Vertebral bone quality score to predict cage subsidence following oblique lumbar interbody fusion

et al. 2023

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Background Current evidence suggests that the magnetic resonance imaging (MRI)-based vertebral bone quality (VBQ) score is a good parameter for evaluating bone quality. We aimed to assess whether the VBQ score can predict the occurrence of postoperative cage subsidence after oblique lumbar interbody fusion (OLIF) surgery. Methods Patients (n = 102) who had undergone single-level OLIF with a minimal follow-up for 1 year were reviewed in this study. Demographic and radiographic data of these patients were collected. Cage subsidence was defined as ≥ 2 mm of cage migration into the inferior endplate, superior endplate, or both. Further, the MRI-based VBQ score was measured on T1-weighted images. Moreover, univariable and multivariable binary logistic regression analyses were performed. Meanwhile, Pearson analysis was used to evaluate the correlation among the VBQ score, average lumbar dual-energy X-ray absorptiometry (DEXA) T-score, and degree of cage subsidence. Furthermore, ad-hoc analysis was used along with receiver operating characteristic curve analysis to assess the predictive ability of the VBQ score and average lumbar DEXA T-score. Results Of 102 participants, cage subsidence was observed in 39 (38.24%) patients. According to the univariable analysis, patients with subsidence had older age, higher antiosteoporotic drug use, larger disk height change, a more concave morphology of inferior and superior endplates, higher VBQ score, and lower average lumbar DEXA T-score compared to patients without subsidence. In the multivariable logistic regression analysis, a higher VBQ score was significantly associated with an increased risk of subsidence (OR = 23.158 ± 0.849, 95% CI 4.381–122.399, p < 0.001), and it was the only significant and independent predictor of subsidence after OLIF. Moreover, the VBQ score was moderately correlated with the average lumbar DEXA T-score (r = − 0.576, p < 0.001) and the amount of cage subsidence (r = 0.649, p < 0.001). Furthermore, this score significantly predicted cage subsidence with an accuracy of 83.9%. Conclusions The VBQ score can independently predict postoperative cage subsidence in patients undergoing OLIF surgery.

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Section: Discussionmentioning

confidence: 99%

Vertebral bone quality score to predict cage subsidence following oblique lumbar interbody fusion

et al. 2023

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“…In our study, the revision rate of patients with cage migration accounted for 1.44%. The causes of cage migration are mainly due to obesity, getting out of bed too early, small interbody fusion cage, abnormal vertebral body shape, improper bone graft material, osteoporosis, bony endplate injury and insufficient opening of contralateral annulus [ 27 – 29 ]. Cage migration usually occurs after SA-LLIF.…”

Section: Discussionmentioning

confidence: 99%

Predictors and tactics for revision surgery in lateral lumbar interbody fusion

Wang

et al. 2022

BMC Musculoskelet Disord

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Background The purpose of this study is to analyze the factors affecting the revision of lateral lumbar interbody fusion (LLIF), and to summarize the complications and decision-making strategies for revision surgery after LLIF. Methods We retrospectively reviewed 21 cases suffered from a revision surgery after LLIF in our department from May 2017 to June 2020, with a mean follow-up of 14 months (12-25months). We collected X-ray plain films, CT (computed tomography), MRI (magnetic resonance imaging) and medical records of all patients undergoing LLIF surgery, then analyzed the reasons for revision and summarized the revision strategies in different situations. We analysed correlations between revision surgery and several factors, including age, body mass index (BMI), sex, bone quality, mode of internal fixation, spinal stenosis, postperative foraminal stenosis, disc height. Then we brought the different indicators into logistic regression to find out the risk factors of revision after LLIF. All these patients were evaluated by Quality-of-life outcomes. Univariate statistical analysis was performed using T-tests, Mann-Whitney U tests and Chi square tests. Results Of the 209 cases of LLIF, 21 patients underwent postoperative revision. All revision surgeries were successfully completed. The reasons for revision included vascular injury, unsatistactory implant placement, internal spinal instrumentation failure, cage migration, indirect decompression failure and infection. Indirect decompression failure was the most common indications for revision. Clinical status was apparently improved in ODI scores and VAS scores. Revision surgery did not impact long-term effect and satisfaction. Postoperative foraminal stenosis is a positive predictor for a revision surgical procedure. Conclusion Patients with postoperative foraminal stenosis are at higher risk of undergoing revision surgery after lateral lumbar interbody fusion. The correct choice of revision surgery can achieve satisfactory clinical results.

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“…One week later, the author performed selective LLIF through a lateral retroperitoneal approach, as previously described [ 14 – 19 ]. Initially, the patients were positioned in a left lateral decubitus position.…”

Section: Methodsmentioning

confidence: 99%

“…With ongoing advancements in surgical techniques and instruments, anterior column realignment (ACR) using retroperitoneal lateral lumbar interbody fusion (LLIF), [ 14 – 16 ] combined with posterior osteotomy, has been widely adopted for the correction of spinal deformities [ 15 – 17 ]. LLIF is a relatively new technique that can be performed via the anterior or trans-psoas approach, allowing the surgeon to access the disc space [ 14 , 18 , 19 ]. In general, ACR is performed first in combined anterior-posterior (A-P) surgery.…”

Section: Introductionmentioning

confidence: 99%

Surgical sequence in anterior column realignment with posterior osteotomy is important for degree of adult spinal deformity correction: advantages and indications for posterior to anterior sequence

Kim

et al. 2022

BMC Musculoskelet Disord

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Background We hypothesized that posterior osteotomy prior to ACR (Anterior column realignment) through P-A-P surgical sequence would permit a greater correction for deformity corrective surgery than the traditional A-P sequence without posterior osteotomy. This study aimed to determine the impact of the P-A-P sequence on the restoration of lumbar lordosis (LL) compared to the A-P sequence in deformity corrective surgery for adult spinal deformity (ASD) patients and to identify the characteristics of patients who require this sequence. Methods Between 2017 and 2019, 260 ASD patients who had undergone combined corrective surgery were reviewed retrospectively. This study included 178 patients who underwent posterior osteotomy before the ACR (P-A group) and 82 patients who underwent the A-P sequence (A-P group). Sagittal spinopelvic parameters were determined from pre- and postoperative whole-spine radiographs and compared between the groups. To find better indications for the P-A-P sequence, we conducted additional analysis on postoperative outcomes of patients in the A-P group. Results The P-A group showed a significantly higher change in LL (53.7° vs. 44.3°, p < 0.001), C7 sagittal vertical axis (C7 SVA: 197.4 mm vs. 146.1 mm, p = 0.021), segmental lordosis (SL) L2/3 (16.2° vs. 14.4°, p = 0.043), SL L3/4 (16.2° vs. 13.8°, p = 0.004), and SL L4/5 (15.1° vs. 11.3°, p = 0.001) compared to the A-P group. At the final follow-up, pelvic incidence (PI) minus LL mismatch (PI − LL mismatch) was significantly higher in the A-P group (13.4° vs. 2.9°, p < 0.001). Stepwise logistic regression analysis showed that age ≥ 75 years (odds ratio [OR] = 2.151; 95% confidence interval [CI], 1.414–3.272; p < 0.001), severe osteoporosis (OR = 2.824; 95% CI, 1.481–5.381; p = 0.002), rigid lumbar curve with dynamic changes in LL < 10° (OR = 5.150; 95% CI, 2.296–11.548; p < 0.001), and severe facet joint osteoarthritis (OR = 4.513; 95% CI, 1.958–10.402; p < 0.001) were independent risk factors for PI − LL mismatch ≥ 10° after A-P surgery. Conclusion P-A-P sequence for deformity corrective surgery in ASD offers greater LL correction than the A-P sequence. Indications for the procedure include patients aged ≥ 75 years, severe osteoporosis, rigid lumbar curve with dynamic change in LL < 10°, or more than four facet joints of Pathria grade 3 in the lumbar region.

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Comparative Study of Cage Subsidence in Single-Level Lateral Lumbar Interbody Fusion

Cited by 21 publications

References 43 publications

Vertebral bone quality score to predict cage subsidence following oblique lumbar interbody fusion

Vertebral bone quality score to predict cage subsidence following oblique lumbar interbody fusion

Predictors and tactics for revision surgery in lateral lumbar interbody fusion

Surgical sequence in anterior column realignment with posterior osteotomy is important for degree of adult spinal deformity correction: advantages and indications for posterior to anterior sequence

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