Perioperative Risk Factors for Early Revisions in Stand-Alone Lateral Lumbar Interbody Fusion

Rentenberger, Colleen; Okano, Ichiro; Salzmann, Stephan N.; Winter, Fabian; Plais, Nicolas; Burkhard, Marco D.; Shue, Jennifer; Sama, Andrew A.; Cammisa, Frank P.; Girardi, Federico P.; Hughes, Alexander P.

doi:10.1016/j.wneu.2019.10.164

Cited by 24 publications

(20 citation statements)

References 38 publications

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“…11,18,19 Although many reports have published subsidence rates, there is no single, established method to measure subsidence, with many papers using different methods such as CT and radiography. [19][20][21] Rentenberger et al 1 had used a grading scale defined by Marchi et al 11 to report subsidence. The scale proposed by Marchi et al (which is the one used in our study) uses a continuous quantitative variable (percentage of subsidence) and is reported in an ordinal fashion (4-point severity scale); furthermore, they defined grades 0 and I as mild subsidence and grades II and III as severe subsidence.…”

Section: Discussionmentioning

confidence: 99%

“…11 Previous reports have shown that older age, female sex, endplate injury, endplate cystic lesion (Schmorl's nodes), cage size, unilateral pedicle screw fixation, and osteoporosis may be risk factors for cage subsidence. [1][2][3][4]22 Because osteoporosis reflects low BMD, it is important to consider BMD prior to LLIF. [23][24][25] As a general rule, bone density is measured by DXA, but not all patients obtain a preoperative DXA scan.…”

Section: Discussionmentioning

confidence: 99%

“…For the subsidence risk analysis, patients were divided into two groups defined by previously published studies as mild subsidence (grades 0-I) and severe subsidence (grades II-III). 1,11…”

Section: Subsidence Gradingmentioning

confidence: 99%

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The association between lower Hounsfield units on computed tomography and cage subsidence after lateral lumbar interbody fusion

Mummaneni²,

Wang³

et al. 2020

Neurosurgical Focus

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OBJECTIVEOne vexing problem after lateral lumbar interbody fusion (LLIF) surgery is cage subsidence. Low bone mineral density (BMD) may contribute to subsidence, and BMD is correlated with Hounsfield units (HUs) on CT. The authors investigated if lower HU values correlated with subsidence after LLIF.METHODSA retrospective study of patients undergoing single-level LLIF with pedicle screw fixation for degenerative conditions at the University of California, San Francisco, by 6 spine surgeons was performed. Data on demographics, cage parameters, preoperative HUs on CT, and postoperative subsidence were collected. Thirty-six–inch standing radiographs were used to measure segmental lordosis, disc space height, and subsidence; data were collected immediately postoperatively and at 1 year. Subsidence was graded using a published grade of disc height loss: grade 0, 0%–24%; grade I, 25%–49%; grade II, 50%–74%; and grade III, 75%–100%. HU values were measured on preoperative CT from L1 to L5, and each lumbar vertebral body HU was measured 4 separate times.RESULTSAfter identifying 138 patients who underwent LLIF, 68 met the study inclusion criteria. All patients had single-level LLIF with pedicle screw fixation. The mean follow-up duration was 25.3 ± 10.4 months. There were 40 patients who had grade 0 subsidence, 15 grade I, 9 grade II, and 4 grade III. There were no significant differences in age, sex, BMI, or smoking. There were no significant differences in cage sizes, cage lordosis, and preoperative disc height. The mean segmental HU (the average HU value of the two vertebrae above and below the LLIF) was 169.5 ± 45 for grade 0, 130.3 ± 56.2 for grade I, 100.7 ± 30.2 for grade II, and 119.9 ± 52.9 for grade III (p < 0.001). After using a receiver operating characteristic curve to establish separation criteria between mild and severe subsidence, the most appropriate threshold of HU value was 135.02 between mild and severe subsidence (sensitivity 60%, specificity 92.3%). After univariate and multivariate analysis, preoperative segmental HU value was an independent risk factor for severe cage subsidence (p = 0.017, OR 15.694, 95% CI 1.621–151.961).CONCLUSIONSLower HU values on preoperative CT are associated with cage subsidence after LLIF. Measurement of preoperative HU values on CT may be useful when planning LLIF surgery.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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The association between lower Hounsfield units on computed tomography and cage subsidence after lateral lumbar interbody fusion

Mummaneni²,

Wang³

et al. 2020

Neurosurgical Focus

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“…However, some previous studies have reported no significant difference in leg pain VAS between patients with or without cage subsidence following indirect decompressions (both OLIF and DLIF) [ 84 - 86 ]. In addition, there are conflicting results on whether cage subsidence increases the risk of pseudarthrosis and revision surgery [ 87 - 89 ]. Therefore, more future studies are required to verify the clinical significance of cage subsidence following indirect decompression.…”

Section: Complications Requiring Special Considerationsmentioning

confidence: 99%

Pearls and Pitfalls of Oblique Lateral Interbody Fusion: A Comprehensive Narrative Review

Kim

Chang

2022

Neurospine

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Lumbar degenerative disease is a common problem in an aging society. Oblique lateral interbody fusion (OLIF) is a minimally invasive surgical (MIS) technique that utilizes a retroperitoneal antepsoas corridor to treat lumbar degenerative disease. OLIF has theoretical advantages over other lumbar fusion techniques, such as a lower risk of lumbar plexus injury than direct lateral interbody fusion (DLIF). Previous studies have reported favorable clinical and radiological outcomes of OLIF in various lumbar degenerative diseases. The use of OLIF is increasing, and evidence on OLIF is growing in the literature. The indications for OLIF are also expanding with the help of recent technical developments, including stereotactic navigation systems and robotics. In this review, we present current evidence on OLIF for the treatment of lumbar degenerative disease, focusing on the expansion of surgical indications and recent advancements in the OLIF procedure.

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“…The causes of failure were identified to be cage subsidence, loss of sagittal alignment correction, and persistent central and foraminal stenosis. Rentenberger et al [ 20 ] reported an 18.8% surgical revision rate due to neurological symptoms, pain, or radiculopathy, while other studies have reported significantly higher failure rates. The rate of additional posterior decompression after XLIF was 60% in a study reported by Kim et al [ 21 ], and Park et al [ 8 ] reported that the need for direct decompression and instrumentation in a second operation was as high as 72.1% in patients with leg pain that improved ≤ 50% after the index procedure.…”

Section: Discussionmentioning

confidence: 99%

Successful Criteria for Indirect Decompression With Lateral Lumbar Interbody Fusion

et al. 2022

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Purpose: No consensus criteria have been established regarding ideal candidates for indirect decompression with lateral lumbar interbody fusion (LLIF), and contributing factors of indirect decompression failure were rarely reported. We aim to investigate the success rate of indirect decompression by LLIF with proposed selection criteria and identify risk factors associated with indirect decompression failure, defined as persistent pain requiring revision with direct decompression. Methods: Data from 191 patients undergoing LLIF were retrospectively reviewed. All the following criteria must be fulfilled: 1) dynamic clinical symptoms (pain relief in supine position), 2) presence of reducible disc height (recovered disc height in supine position), 3) no profound weakness and 4) no static stenosis. The success rate of indirect decompression with LLIF and results after at least 1-year of follow-up were collected. Preoperative, procedure-related, and postoperative factors were assessed for their relationship with failure. Results: Of 191 patients,13 patients (6.8%) required additional direct decompression due to persistent pain, giving a criteria success rate of 93.2%. Factors associated with indirect decompression failure included low bone mineral density (BMD) (T-score < 2.1), low reducible disc height (<13%), low postoperative disc height (<10 mm), high-grade cage subsidence, and use of plate fixation. Conclusion: We proposed patient selection criteria for indirect decompression with LLIF which had a satisfactory success rate and identified factors associated with the need for additional direct decompression. Our proposed criteria may assist selection of patients likely to achieve good results following indirect decompression with LLIF, and optimize selection based on risk factors of failure.

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Perioperative Risk Factors for Early Revisions in Stand-Alone Lateral Lumbar Interbody Fusion

Cited by 24 publications

References 38 publications

The association between lower Hounsfield units on computed tomography and cage subsidence after lateral lumbar interbody fusion

The association between lower Hounsfield units on computed tomography and cage subsidence after lateral lumbar interbody fusion

Pearls and Pitfalls of Oblique Lateral Interbody Fusion: A Comprehensive Narrative Review

Successful Criteria for Indirect Decompression With Lateral Lumbar Interbody Fusion

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