Factors Influencing Early Disc Height Loss Following Lateral Lumbar Interbody Fusion

Kaliya-Perumal, Arun-Kumar; Soh, Tamara Lee Ting; Tan, Mark; Oh, Jacob Yoong-Leong

doi:10.31616/asj.2019.0332

Cited by 14 publications

(6 citation statements)

References 26 publications

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“…Kaliya-Perumal et al reported that over-corrected postoperative disc height was correlated with subsequent disc height loss during early follow-up. 19 Accordingly, the study of subsidence following standalone anterior cervical discectomy and fusion cage by Igarashi et al also reported a higher risk of cage subsidence when using greater cage height. 20 Thus, we strongly recommend an optimal cage height of less than 12 mm to avoid excessive mechanical stress on the vertebral endplate.…”

Section: Discussionmentioning

confidence: 99%

Subsidence of Interbody Cage Following Oblique Lateral Interbody Fusion: An Analysis and Potential Risk Factors

Kotheeranurak¹,

Jitpakdee²,

Lin

et al. 2021

Global Spine Journal

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Study Design Retrospective cohort study Objectives This study aimed to report the incidence and potential risk factors of polyetheretherketone (PEEK) cage subsidence following oblique lateral interbody fusion (OLIF) for lumbar degenerative diseases. We proposed also an algorithm to minimize subsidence following OLIF surgery. Methods The study included a retrospective cohort of 107 consecutive patients (48 men and 59 women; mean age, 67.4 years) who had received either single- or multi-level OLIF between 2012 and 2019. Patients were classified into subsidence and non-subsidence groups. PEEK cage subsidence was defined as any violation of either endplate from the computed tomography scan in both sagittal and coronal views. Preoperative variables such as age, sex, body mass index, bone mineral density (BMD) measured by preoperative dual-energy X-ray absorptiometry, smoking status, corticosteroid use, diagnosis, operative level, multifidus muscle cross-sectional area, and multifidus muscle fatty degeneration were collected. Age-related variables (height and length) were also documented. Univariate and multivariate logistic regression analyses were used to analyze the risk factors of subsidence. Results Of the 107 patients (137 levels), 50 (46.7%) met the subsidence criteria. Higher PEEK cage height had the strongest association with subsidence (OR = 9.59, P < .001). Other factors significantly associated with cage subsistence included age >60 years (OR = 3.15, P = .018), BMD <−2.5 (OR = 2.78, P = .006), and severe multifidus muscle fatty degeneration (OR = 1.97, P = .023). Conclusions Risk factors for subsidence in OLIF were age >60 years, BMD < −2.5, higher cage height, and severe multifidus muscle fatty degeneration. Patients who had subsidence had worse early (3 months) postoperative back and leg pain.

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Section: Discussionmentioning

confidence: 99%

Subsidence of Interbody Cage Following Oblique Lateral Interbody Fusion: An Analysis and Potential Risk Factors

Kotheeranurak¹,

Jitpakdee²,

Lin

et al. 2021

Global Spine Journal

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“…The preoperative DH, FH, SA, and LL values in the 11-mm cage height group were smaller than those in the 13-mm cage height group; however, the group had similar DH, FH, and SA but not LL immediately postoperatively and at 12 months later, demonstrating the strong lumbar alignment restoration of the cage and the importance of its proper cage height in the LLIF procedure. Previous study demonstrated that optimal cage height in LLIF was important because the postoperative increase in disc height and the disc height loss at the final follow-up were closely associated [24]. Barone et al [9] demonstrated that disc angle and lumbar lordosis restorations were effective because lordotic cages were utilized in the LLIF, with the improvement magnitude significantly higher in the lower cage height group for DH, FH, SA, and LL immediately postoperatively and at final follow-up.…”

Section: Discussionmentioning

confidence: 97%

Effects of the cage height and positioning on clinical and radiographic outcome of lateral lumbar interbody fusion: a retrospective study

Bian

Liu

et al. 2022

BMC Musculoskelet Disord

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Background The proper cage positioning and height in lateral lumbar interbody fusion (LLIF). This study evaluated their effects on clinical and radiographic outcome measures in patients undergoing LLIF. Methods This single-center retrospective study analyzed the characteristics and perioperative data of patients who underwent LLIF between January 2019 and December 2020. Radiographic (lumbar lordosis [LL], foraminal height, disc height [DH], segmental angle [SA], cross-sectional area [CSA] of thecal sac) and clinical (Oswestry Disability Index and Visual Analog Scale) outcomes were assessed preoperatively, postoperatively, and at the last follow-up. The effects of cage height and positioning on these parameters were also investigated. Results With a mean follow-up of 12.8 months, 47 patients with 70 operated level were analyzed. Data demonstrated that postsurgical clinical and radiographic outcome measures were significantly better than before surgery(P < 0.05). Cage height and positioning showed no significant difference with regarding to clinical outcome(P > 0.05). Subgroup analysis of the cage positioning showed that DH and SA were better restored by the final follow-up in patients with anteriorly placed cages than those with posteriorly placed cages (P < 0.05). Cages of posterior position showed significantly upgrading cage subsidence (P = 0.047). Cage height subgroup analysis showed that the preoperative forminal height, DH, and SA in the 11-mm cage group were significantly lower than in the 13-mm cage group; however, these parameters were comparable in the two groups postoperatively and at the final follow-up (P > 0.05). Furthermore, the postoperative and final follow-up degrees of DH, SA, and LL have improved in the 11-mm cage group more than the 13-mm cage group. The preoperative, postoperative, and final follow-up LL values in the 11-mm cage group were lower than in the 13-mm cage group(P < 0.01). Conclusions Cage height and positioning did not affect the clinical outcomes in the present study. Cages in anterior position showed better restoration in DH, SA and decreased the incidence of cage subsidence. A comparable radiographic outcome can be achieved by inserting an appropriate cage height based on preoperative radiography.

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“…Therefore, the surgeon may consider placing a larger cage in a narrow disc space for indirect decompression at LLIF. It has also been reported that the greater the postoperative increase in DH by LLIF, the greater the DH loss throughout early follow-up [ 32 ]. This means that greater cage height has been shown to increase the risk of cage subsidence.…”

Section: Discussionmentioning

confidence: 99%

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

Hiyama

Sakai

Katoh

et al. 2022

JCM

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We investigated the incidence and clinical features of cage subsidence after single-level lateral lumbar interbody fusion (LLIF). We studied a retrospective cohort of 59 patients (34 males, 25 females; mean age, 68.9 years) who received single-level LLIF. Patients were classified into subsidence and no-subsidence groups. Cage subsidence was defined as any violation of either endplate, classified using radiographs and computed tomography (CT) images. After one year, we compared patient characteristics, surgical parameters, radiological findings, pain scores, and fusion status. We also compared the Hounsfield unit (HU) endplate value obtained on CT preoperatively. Twenty patients (33.9%) had radiographic evidence of interbody cage subsidence. There were significant differences between the subsidence and no-subsidence groups in sex, cage height, fusion rate, and average HU value of both endplates (p < 0.05). There were no significant differences in age, height, weight, or body mass index. Moreover, there were no significant differences in global alignment and Numerical Rating Scale change in low back pain, leg pain, and numbness. Despite suggestions that patients with lower HU values might develop cage subsidence, our results showed that cage subsidence after single-level LLIF was not associated with low back pain, leg pain, or numbness one year post-operation.

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Factors Influencing Early Disc Height Loss Following Lateral Lumbar Interbody Fusion

Cited by 14 publications

References 26 publications

Subsidence of Interbody Cage Following Oblique Lateral Interbody Fusion: An Analysis and Potential Risk Factors

Subsidence of Interbody Cage Following Oblique Lateral Interbody Fusion: An Analysis and Potential Risk Factors

Effects of the cage height and positioning on clinical and radiographic outcome of lateral lumbar interbody fusion: a retrospective study

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

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