Do the positioning variables of the cage contribute to adjacent facet joint degeneration? Radiological and clinical analysis following intervertebral fusion

Abstract

Background: Compared to other risk factors, adjacent facet joint degeneration (AFD) is the main contributor to adjacent segment disease (ASD). The interbody cage may be a potential indirect risk of AFD.This study investigated the correlations among the lumbar sagittal balance parameters, the inter-body cage's intraoperative positioning variables, and adjacent facet joint degeneration following the transforaminal lumbar interbody fusion (TLIF) technique.Methods: Patients who accepted single-level TLIF for symptomatic lumbar degenerative disease and were followed up for at least six months were enrolled in this study. According to the inclusive and exclusive criteria, 93 patients were included (44 males and 49 females). X-ray and computed tomography (CT) images were obtained before and six months after surgery. The vertebral contour and the center of the marker mass in the cage were calculated using a geometric algorithm. Orthopedic surgeons measured the disc height, lordosis angle, and facet joint degeneration. Patient-reported outcomes, including the Oswestry Disability Index (ODI) and the visual analog scale (VAS), were used to assess the clinical outcomes. The Student's t-test, Wilcoxon rank-sum test, and Chi-square test were used for the statistical analyses. Results:The average age was 53.7 years old (range, 27-84 years). The average functional disability outcome assessed by the ODI was 61.2, and the average back and leg pain assessed by the VAS was 6.2 and 6.9, respectively. The patients were categorized into a normal group and an abnormal (AFD) group according to whether the facet joint degeneration was aggravated. The abnormal group had a higher back pain VAS score (P=0.031) and lower sagittal vertical position (P=0.027). The other parameters were similar at baseline (P>0.05). The cage's sagittal vertical position decreased significantly with AFD aggravation (OR, 0.737; 95% CI, 0.561-0.969). Conclusions:In patients with AFD aggravation, the preoperative VAS and postoperative ODI scores were significantly higher. The cage position parameters were related to AFD. A lower cage center was associated with a greater incidence of AFD.

Impact of cage position on biomechanical performance of stand-alone lateral lumbar interbody fusion: a finite element analysis

“…Regarding the location of the cage in lumbar fusion, investigators have also conducted clinical and mechanics studies. A previous study [ 29 ] showed a lower cage center was more liable to cause adjacent facet joint degeneration (AFD) following the transforaminal lumbar interbody fusion (TLIF). Yan Liang [ 30 ] advised the cage should be placed in traverse orientation in TLIF.…”

Caudad Insertion of Pedicle Screws Facilitates Interbody Distraction During Spondylolisthetic Vertebrae Restoration: A Retrospective Study

“…Cage parameters were measured as shown in Fig. 2 B, C. Our preliminary study [ 18 ] on how the positioning variables of the cage contribute to adjacent facet joint degeneration showed that the method of measurement of cage parameters (and not explained here).…”

“…2B, C. Our preliminary study [18] on how the positioning variables of the cage contribute to adjacent facet joint degeneration showed Fig. 1 Measurement of lumbar sagittal parameters.…”

Correlation between direction of pedicle screw and restoration of lumbar degenerative scoliosis in degenerative lumbar spondylolisthesis: a retrospective study

“…Coronal asymmetric intervertebral space was demonstrated by the intervertebral height difference (IHD) between the medial and lateral margin of the indexed intersegmental space (IHD:|RIH-LIH|) (17). Implant parameters included the angle of the upper/lower pedicle screws (Figure 1B), and the horizontal position of cage (%, normalized to endplate size) (18).…”

“…Radiographic measurements were performed on X-ray images using a custom-written MATLAB program (MathWorks, Natick, MA, USA) (18). Intraclass correlation coefficient (ICC) was used to evaluate the consistency of pedicle screw-related complications and segmental fusion based on computed tomography (CT) 1 year after surgery between 2 visits.…”