Risk Factors for Cage Retropulsion After Posterior Lumbar Interbody Fusion

Kimura, Hiroaki; Shikata, Jitsuhiko; Odate, Seiichi; Soeda, Tsunemitsu; Yamamura, Satoru

doi:10.1097/brs.0b013e318257f12a

Cited by 94 publications

(110 citation statements)

References 21 publications

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“…Moreover, Kimura et al reported that a PLIF at the level L5/S1, a wide disc space with instability, multilevel fusion surgery, and a pear-shaped disc space on lateral radiographs are risk factors for a cage retropulsion (Table 1) [3].…”

Section: Discussionmentioning

confidence: 99%

“…Less frequently, cage migration and/or cage subsidence may occur months to years after lumbar interbody fusion procedures. Besides a putative development of a segmental kyphosis and a disposition to pseudoarthrosis, these complications can lead to progressive compression of nervous structures, resulting in disabling recurrent pain and/or significant sensori motor sequelae, necessitating revision surgery [3].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Complete cage migration/subsidence into the adjacent vertebral body after posterior lumbar interbody fusion

Corniola¹,

Jägersberg²,

Stienen³

et al. 2015

Journal of Clinical Neuroscience

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Complete cage migration/subsidence into the adjacent vertebral body after posterior lumbar interbody fusion

Corniola¹,

Jägersberg²,

Stienen³

et al. 2015

Journal of Clinical Neuroscience

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“…As a result, it is associated with higher risks of cerebrospinal fluid leakage, dysesthetic nerve pain syndrome, nerve root injury, epidural fibrosis, as well as cage migration [9][10][11].In our study, multivariate analysis was used to account for potential covariates and identify factors associated with an increased complication risk -the only peri-operative complications occurred in the PLIF group, with 2 cases of dural tears, 2 cases of epidural hematomas, and 2 cases of dysesthetic nerve pain syndrome secondary to genitofemoral nerve injury.…”

Section: Discussionmentioning

confidence: 99%

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2014

MOJOR

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“…The authors believe that this is due to the angle of L-5 with respect to S-1-which is generally higher than any other lumbar segment. 1,19,28,36 To achieve this angle, the anatomy is such that the posterior edge of the annulus is shorter in height than the anterior. 39 The authors believe that this shorter annulus could affect the intact rigidness by resisting compressive loads, which would cause higher stiffness.…”

Section: Discussionmentioning

confidence: 99%

The role of sacral slope in lumbosacral fusion: a biomechanical study

Drazin¹,

Hussain

Harris

et al. 2015

SPI

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OBJECT Abnormal sacral slope (SS) has shown to increase progression of spondylolisthesis, yet there exists a paucity in biomechanical studies investigating its role in the correction of adult spinal deformity, its influence on lumbosacral shear, and its impact on the instrumentation selection process. This in vitro study investigates the effect of SS on 3 anterior lumbar interbody fusion constructs in a biomechanics laboratory. METHODS Nine healthy, fresh-frozen, intact human lumbosacral vertebral segments were tested by applying a 550-N axial load to specimens with an initial SS of 20° on an MTS Bionix test system. Testing was repeated as SS was increased to 50°, in 10° increments, through an angulated testing fixture. Specimens were instrumented using a standalone integrated spacer with self-contained screws (SA), an interbody spacer with posterior pedicle screws (PPS), and an interbody spacer with anterior tension band plate (ATB) in a randomized order. Stiffness was calculated from the linear portion of the load-deformation curve. Ultimate strength was also recorded on the final construct of all specimens (n = 3 per construct) with SS of 40°. RESULTS Axial stiffness (N/mm) of the L5–S1 motion segment was measured at various angles of SS: for SA 292.9 ± 142.8 (20°), 277.2 ± 113.7 (30°), 237.0 ± 108.7 (40°), 170.3 ± 74.1 (50°); for PPS 371.2 ± 237.5 (20°), 319.8 ± 167.2 (30°), 280.4 ± 151.7 (40°), 233.0 ± 117.6 (50°); and for ATB 323.9 ± 210.4 (20°), 307.8 ± 125.4 (30°), 249.4 ± 126.7 (40°), 217.7 ± 99.4 (50°). Axial compression across the disc space decreased with increasing SS, indicating that SS beyond 40° threshold shifted L5–S1 motion into pure shear, instead of compression-shear, defining a threshold. Trends in ultimate load and displacement differed from linear stiffness with SA > PPS > ATB. CONCLUSIONS At larger SSs, bilateral pedicle screw constructs with spacers were the most stable; however, none of the constructs were significantly stiffer than intact segments. For load to failure, the integrated spacer performed the best; this may be due to angulations of integrated plate screws. Increasing SS significantly reduced stiffness, which indicates that surgeons need to consider using more aggressive fixation techniques.

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Risk Factors for Cage Retropulsion After Posterior Lumbar Interbody Fusion

Cited by 94 publications

References 21 publications

Complete cage migration/subsidence into the adjacent vertebral body after posterior lumbar interbody fusion

Complete cage migration/subsidence into the adjacent vertebral body after posterior lumbar interbody fusion

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The role of sacral slope in lumbosacral fusion: a biomechanical study

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