Effect of Cage in Radiological Differences between Direct and Oblique Lateral Interbody Fusion Techniques

Ko, Myeong Jin; Park, Seung Won; Kim, Young Baeg

doi:10.3340/jkns.2018.0142

“…The questionnaire-based clinical outcomes in our cohort showed signi cant improvements in symptoms and function at 6 months after surgery compared with preoperative values, regardless of the xation pattern, which was consistent with previous studies[6, 50,51]. The change in the VAS score for leg pain did not differ among the three groups, indicating that indirect decompression can be achieved and maintained by the stand-alone technique.…”

Section: Discussionsupporting

confidence: 90%

Comparison of clinical outcomes achieved with oblique lateral interbody fusion with or without supplementary instrumentation in patients with single-level lumbar degenerative disease

Lang

¹

,

Sun

²

,

Yuan

³

et al. 2021

Preprint

0

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Background Oblique lateral interbody fusion (OLIF) is applied often to treat degenerative disc disease in the lumbar spine. Stand-alone OLIF prevents morbidities associated with supplemental fixation and is less expensive. However, it remains controversial whether stand-alone OLIF is sufficient to avoid subsidence for single-level diseases. Additionally, bilateral pedicle screw (BPS) and bilateral transfacet screw (BTS) fixation are well-established posterior fixation methods that can offer improved biomechanical stability. But the comparison of clinical outcomes of OLIF with and without supplementary instrumentation is lack. Methods We retrospectively examined 20 patients who underwent single-level stand-alone OLIF for symptomatic lumbar degenerative disease at L1–L5 (SA group). Groups of patients treated with OLIF plus BPS (n = 20, BPS group) or BTS (n = 20, BTS group) were matched for age, sex, diagnosis, operative level, body mass index, and bone mineral density. The disk height index (DHI), segmental lordotic (SL) angle, and lumbar lordotic (LL) angle were measured preoperatively and at 3 days and 6 months postoperatively. Clinical outcomes were evaluated. Results Significant disc height loss was observed in all groups, but was greater in the SA and BTS groups than in the BPS group at the 6-month follow-up. The SL and LL angles were not affected in any group. The operative time was significantly less in the SA group, and the estimated blood loss was significantly higher in the BPS group. At 6 months post-surgery, improvements in clinical outcomes were evident in all groups, but the VAS (back pain), JOA, and ODI scores were worse in the SA group than in the other groups. Conclusions Stand-alone OLIF was associated with greater subsidence and poorer clinical outcomes compared with OLIF plus supplementary instrumentation. The addition of BTS did not decrease the degree of subsidence, but provided clinical outcomes comparable to those achieved with BPS.

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“…The questionnaire-based clinical outcomes in our cohort showed signi cant improvements in symptoms and function at 6 months after surgery compared with preoperative values, regardless of the xation pattern, which was consistent with previous studies [6,50,51]. The change in the VAS score for leg pain did not differ among the three groups, indicating that indirect decompression can be achieved and maintained by the stand-alone technique.…”

Section: Discussionsupporting

confidence: 90%

Comparison of clinical outcomes achieved with oblique lateral interbody fusion with or without supplementary instrumentation in patients with single-level lumbar degenerative disease

Lang

¹

,

Sun

²

,

Yuan

³

et al. 2021

Preprint

0

View full text Add to dashboard Cite

Background Oblique lateral interbody fusion (OLIF) is applied often to treat degenerative disc disease in the lumbar spine. Stand-alone OLIF prevents morbidities associated with supplemental fixation and is less expensive. However, it remains controversial whether stand-alone OLIF is sufficient to avoid subsidence for single-level diseases. Additionally, bilateral pedicle screw (BPS) and bilateral transfacet screw (BTS) fixation are well-established posterior fixation methods that can offer improved biomechanical stability. But the comparison of clinical outcomes of OLIF with and without supplementary instrumentation is lack. Methods We retrospectively examined 20 patients who underwent single-level stand-alone OLIF for symptomatic lumbar degenerative disease at L1–L5 (SA group). Groups of patients treated with OLIF plus BPS (n = 20, BPS group) or BTS (n = 20, BTS group) were matched for age, sex, diagnosis, operative level, body mass index, and bone mineral density. The disk height index (DHI), segmental lordotic (SL) angle, and lumbar lordotic (LL) angle were measured preoperatively and at 3 days and 6 months postoperatively. Clinical outcomes were evaluated. Results Significant disc height loss was observed in all groups, but was greater in the SA and BTS groups than in the BPS group at the 6-month follow-up. The SL and LL angles were not affected in any group. The operative time was significantly less in the SA group, and the estimated blood loss was significantly higher in the BPS group. At 6 months post-surgery, improvements in clinical outcomes were evident in all groups, but the VAS (back pain), JOA, and ODI scores were worse in the SA group than in the other groups. Conclusions Stand-alone OLIF was associated with greater subsidence and poorer clinical outcomes compared with OLIF plus supplementary instrumentation. The addition of BTS did not decrease the degree of subsidence, but provided clinical outcomes comparable to those achieved with BPS.

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“…Thus, the authors suggested posterior medial cage placement for PLIF. However, Ko et al [31] found that the rate of cage subsidence increases with a more posterior cage position. A previous study [27] shows that the inferior endplate is approximately 40% stronger than is the superior endplate, and the subsidence probability of the superior endplate is signi cantly higher than that of the inferior endplate [32][33] .…”

Section: Discussionmentioning

confidence: 98%

Biomechanical effect of cage position combined with bilateral pedicle screw fixation in the osteoporotic lumbar spine of oblique lumbar interbody fusion: a finite element analysis

Qin¹,

Zhao²,

Yuan³

et al. 2021

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0

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Background: The influence of cage position on postoperative cage subsidence has been paid increasing attention. The best cage position in oblique lumbar interbody fusion (OLIF) is still unclear. This study aimed to evaluate the biomechanical effects of different cage positions with stand-alone (SA) methods and bilateral pedicle screw fixation (BPSF) in the osteoporotic lumbar spine after OLIF.Methods: A finite element (FE) model of an intact L3-L5 lumbar spine was constructed. After validation, an osteoporosis model (OP) was constructed by assigning osteoporotic material properties. SA models (SA1, SA2, SA3) and BPSF models (BPSF1, BPSF2, BPSF3) in which a cage was placed in the anterior, middle and posterior third of the L5 superior endplate (SEP) were constructed at the L4-L5 segment of the OP. The L4-L5 range of motion (ROM), the stress of the L5 SEP, the stress of the cage and the stress of fixation were compared among the different models.Results: According to the degree of ROM of L4-L5, the stress of the L5 SEP and the stress of the cage for most physiological motions, the SA and BPSF models were ranked as follows: SA2＜SA1＜SA3, BPSF2＜BPSF1＜BPSF3. In BPSF2, the stress of fixation was minimal in most motions. At the same cage position, the ROM of L4-L5, the stress of the L5 SEP and the stress of the cage in the BPSF models were significantly reduced compared with those in SA models; compared with SA2, BPSF2 had a maximum reduction of 83.24%, 70.71% and 73.52% in these parameters, respectively.Conclusions: Placing the cage in the middle third of the L5 SEP for OLIF could reduce the maximum stresses of the L5 SEP, the cage and the fixation, which may reduce the risk of postoperative cage subsidence, endplate collapse and fixation fracture in the osteoporotic lumbar spine. Compared with SA OLIF, BPSF could provide sufficient stability for the surgical segment and may reduce the incidence of the aforementioned complications.

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Effect of Cage in Radiological Differences between Direct and Oblique Lateral Interbody Fusion Techniques

Cited by 25 publications

References 42 publications

Comparison of clinical outcomes achieved with oblique lateral interbody fusion with or without supplementary instrumentation in patients with single-level lumbar degenerative disease

Comparison of clinical outcomes achieved with oblique lateral interbody fusion with or without supplementary instrumentation in patients with single-level lumbar degenerative disease

Comparison of clinical outcomes achieved with oblique lateral interbody fusion with or without supplementary instrumentation in patients with single-level lumbar degenerative disease

Biomechanical effect of cage position combined with bilateral pedicle screw fixation in the osteoporotic lumbar spine of oblique lumbar interbody fusion: a finite element analysis

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