Minimally invasive anterior lumbar interbody fusion followed by percutaneous translaminar facet screw fixation in elderly patients

Park, Sung Hun; Park, Woo Min; Park, Cheul Woong; Kang, Kwan Soo; Lee, Young Keun; Lim, Sang Rak

doi:10.3171/2009.2.spine08360

Cited by 27 publications

(15 citation statements)

References 20 publications

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“…54 Conversely, osteoporosis, age, and multilevel procedures have been found to be related to subsidence in other reports. 8,26,44 The current results corroborate subsidence predisposition across 2 variables: female sex and older age. These 2 demographic variables are strongly correlated with low bone quality, which likely contributed to endplate failure, 26 although bone mineral density data were not available for the current analysis.…”

Section: Discussionsupporting

confidence: 92%

Radiographic and clinical evaluation of cage subsidence after stand-alone lateral interbody fusion

Marchi

Abdala

Oliveira

et al. 2013

SPI

382

296

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Object Indirect decompression of the neural structures through interbody distraction and fusion in the lumbar spine is feasible, but cage subsidence may limit maintenance of the initial decompression. The influence of interbody cage size on subsidence and symptoms in minimally invasive lateral interbody fusion is heretofore unreported. The authors report the rate of cage subsidence after lateral interbody fusion, examine the clinical effects, and present a subsidence classification scale. Methods The study was performed as an institutional review board–approved prospective, nonrandomized, comparative, single-center radiographic and clinical evaluation. Stand-alone short-segment (1- or 2-level) lateral lumbar interbody fusion was investigated with 12 months of postoperative follow-up. Two groups were compared. Forty-six patients underwent treatment at 61 lumbar levels with standard interbody cages (18 mm anterior/posterior dimension), and 28 patients underwent treatment at 37 lumbar levels with wide cages (22 mm). Standing lateral radiographs were used to measure segmental lumbar lordosis, disc height, and rate of subsidence. Subsidence was classified using the following scale: Grade 0, 0%–24% loss of postoperative disc height; Grade I, 25%–49%; Grade II, 50%–74%; and Grade III, 75%–100%. Fusion status was assessed on CT scanning, and pain and disability were assessed using the visual analog scale and Oswestry Disability Index. Complications and reoperations were recorded. Results Pain and disability improved similarly in both groups. While significant gains in segmental lumbar lordosis and disc height were observed overall, the standard group experienced less improvement due to the higher rate of interbody graft subsidence. A difference in the rate of subsidence between the groups was evident at 6 weeks (p = 0.027), 3 months (p = 0.042), and 12 months (p = 0.047). At 12 months, 70% in the standard group and 89% in the wide group had Grade 0 or I subsidence, and 30% in the standard group and 11% in wide group had Grade II or III subsidence. Subsidence was detected early (6 weeks), at which point it was correlated with transient clinical worsening, although progression of subsidence was not observed after the 6-week time point. Moreover, subsidence occurred predominantly (68%) in the inferior endplate. Fusion rate was not affected by cage dimension (p > 0.999) or by incidence of subsidence (p = 0.383). Conclusions Wider cages avoid subsidence and better restore segmental lordosis in stand-alone lateral interbody fusion. Cage subsidence is identified early in follow-up and can be accessed using the proposed classification scale.

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Section: Discussionsupporting

confidence: 92%

Radiographic and clinical evaluation of cage subsidence after stand-alone lateral interbody fusion

Marchi

Abdala

Oliveira

et al. 2013

SPI

382

296

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“…Several factors are reported to cause cage subsidence in intervertebral fusions including LIF: reduced bone quality 12,13) , older age 13) , multilevel procedures 1,14) , narrow cage 1,2) , and use of rhBMP-2 15) . However, the abovementioned reports mixed two types of cage subsidence (intraoperative injury and postoperative spontaneous settling).…”

Section: Discussionmentioning

confidence: 99%

Cage subsidence in lateral interbody fusion with transpsoas approach: intraoperative endplate injury or late-onset settling

Satake

Kanemura

Nakashima

et al. 2017

Spine Surg Relat Res

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Abstract:Introduction: Few studies have investigated the influence of cage subsidence patterns (intraoperative endplate injury or late-onset cage settling) on bony fusion and clinical outcomes in lateral interbody fusion (LIF). This retrospective study was performed to compare the fusion rate and clinical outcomes of cage subsidence patterns in LIF at one year after surgery.Methods: Participants included 93 patients (aged 69.0±0.8 years; 184 segments) who underwent LIF with bilateral pedicle screw fixation. All segments were evaluated by computed tomography and classified into three groups: Segment E (intraoperative endplate injury, identified immediately postoperatively); Segment S (late-onset settling, identified at 3 months or later); or Segment N (no subsidence). We compared patient characteristics, surgical parameters and fusion status at 1 year for the three subsidence groups. Patients were classified into four groups: Group E (at least one Segment E), Group S (at least one Segment S), Group ES (both Segments E and S), or Group N (Segment N alone). Visual analog scales (VASs) and the Japanese Orthopedic Association Back Pain Evaluation Questionnaire (JOABPEQ) were compared for the four patient groups.Results: 184 segments were classified: 31 as Segment E (16.8%), 21 as Segment S (11.4%), and 132 as Segment N (71.7%). Segment E demonstrated significantly lower bone mineral density (-1.7 SD of T-score, p=0.003). Segment S demonstrated a significantly higher rate of polyetheretherketone (PEEK) cages (100%, p=0.03) and a significantly lower fusion rate (23.8%, p=0.01). There were no significant differences in VAS or in any of the JOABPEQ domains among the four patient groups.Conclusions: Intraoperative endplate injury was significantly related to bone quality, and late-onset settling was related to PEEK cages. Late-onset settling demonstrated a worse fusion rate. However, there were no significant differences in clinical outcomes among the subsidence patterns.

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“…The mean duration of our intervention measured 30 min and was less than traditional operation times; another advantage was the near absence of blood loss compared with the surgical average of 200 ml [19]. Moreover, the absence of postoperative pain following percutaneous screw fixation associated with intra-articular and intra-cystic injections potentially decreases postoperative narcotic use and allows for earlier mobilization.…”

Section: Discussionmentioning

confidence: 96%

Percutaneous Facet Screw Fixation in the Treatment of Symptomatic Recurrent Lumbar Facet Joint Cyst: A New Technique

Amoretti

Gallo

Bertrand

et al. 2015

Cardiovasc Intervent Radiol

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We present a case of percutaneous treatment of symptomatic recurrent lumbar facet joint cyst resistant to all medical treatments including facet joint steroid injection. Percutaneous transfacet fixation was then performed at L4-L5 level with a cannulated screw using CT and fluoroscopy guidance. The procedure time was 30 min. Using the visual analog scale (VAS), pain decreased from 9.5, preoperatively, to 0 after the procedure. At 6-month follow-up, an asymptomatic cystic recurrence was observed, which further reduced at the 1-year follow-up. Pain remained stable (VAS at 0) during all follow-ups. CT- and fluoroscopy-guided percutaneous cyst rupture associated with facet screw fixation could be an alternative to surgery in patients suffering from a symptomatic recurrent lumbar facet joint cyst.

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Minimally invasive anterior lumbar interbody fusion followed by percutaneous translaminar facet screw fixation in elderly patients

Cited by 27 publications

References 20 publications

Radiographic and clinical evaluation of cage subsidence after stand-alone lateral interbody fusion

Radiographic and clinical evaluation of cage subsidence after stand-alone lateral interbody fusion

Cage subsidence in lateral interbody fusion with transpsoas approach: intraoperative endplate injury or late-onset settling

Percutaneous Facet Screw Fixation in the Treatment of Symptomatic Recurrent Lumbar Facet Joint Cyst: A New Technique

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