Subsidence of Polyetheretherketone Intervertebral Cages in Minimally Invasive Lateral Retroperitoneal Transpsoas Lumbar Interbody Fusion

Le, Tien; Baaj, Ali A.; Dakwar, Elias; Burkett, Clinton J.; Murray, Gisela; Smith, Donald A.; Uribe, Juan S.

doi:10.1097/brs.0b013e3182458b2f

Cited by 230 publications

(224 citation statements)

References 29 publications

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“…Loosening of the disc due to significant subsidence is another reason for insufficient decompression and reoperation [20] and was found in our study. In addition, osteoporosis may be a significant contributor to deformity and degenerative scoliosis.…”

Section: Discussionsupporting

confidence: 68%

Is the Lateral Transpsoas Approach Feasible for the Treatment of Adult Degenerative Scoliosis?

Castro

Oliveira

Amaral

et al. 2014

Clinical Orthopaedics &Amp; Related Research

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Background Lumbar degenerative scoliosis is a common condition in the elderly. Open traditional surgical approaches are associated with high-morbidity complication rates. Less invasive options may carry fewer risks in this patient population. A minimally disruptive lateral transpsoas retroperitoneal technique to accomplish interbody fusion was developed to avoid the morbidity of traditional open surgery, but this approach as an anterior stand-alone construction has not been reported yet for the treatment of adult degenerative scoliosis.Questions/purposes We determined (1) the clinical outcomes (VAS scores for back and leg, Oswestry Disability Index), (2) the radiographic outcomes (Cobb angle, lumbar lordosis, sacral slope, high-grade subsidence, osseous fusion), and (3) the reoperation and complication rates in an older population undergoing this surgical approach. Methods Between 2004 and 2008, 62 patients were treated surgically for adult degenerative scoliosis, of whom 46 (74%) were treated with stand-alone lateral lumbar interbody fusion; 11 of these (24%) were lost to followup before 24 months, leaving the records of 35 patients (nine men, 26 women; mean ± SD age, 68 ± 10 years) available for this retrospective review. General indications for this approach included neurogenic claudication and radicular symptoms with history of chronic low-back pain. A total of 107 levels were treated (mean, three; range, one to seven). Clinical and radiographic outcomes were assessed at a followup of 24 months.

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Section: Discussionsupporting

confidence: 68%

Is the Lateral Transpsoas Approach Feasible for the Treatment of Adult Degenerative Scoliosis?

Castro

Oliveira

Amaral

et al. 2014

Clinical Orthopaedics &Amp; Related Research

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“…We could not analyze the effect of cage width on endplate injury, as only 18-mm cages were available in our country; this might account for results that differed from those in previous literature 1,2) . In conclusion, intraoperative endplate injury was significantly related to bone quality, and late-onset settling was related to cage type (PEEK cage).…”

Section: Discussionmentioning

confidence: 52%

“…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%

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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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“…12 The consequences may range from a lack of clinical symptoms, to loss of disc height, loss of segmental angulation, acute low back pain, restenosis, or even a fracture of the adjacent vertebral bodies. [12][13][14][15][16] Prevention of cage subsidence is, therefore, an issue of great research interest.…”

Section: Introductionmentioning

confidence: 99%

In Which Patients Is It Possible to Perform Standalone Lateral Lumbar Interbody Fusion Without Cage Subsidence?

et al. 2016

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Objective: To identify the factors related to the non-occurrence of cage subsidence in standalone lateral lumbar interbody fusion procedures. Methods: Case-control study of single level standalone lateral lumbar interbody fusion (LLIF) including 86 cases. Patients without cage subsidence composed the control group (C), while those in the subsidence group (S) developed cage subsidence. Preoperative data were examined to create a risk score based on correlation factors with S group. The proven risk factors were part of an evaluation score. Results: Of the 86 cases included, 72 were in group C and 14 in group S. The following risk factors were more prevalent in group S compared to C group: spondylolisthesis (93% vs 18%; p<0.001); scoliosis (31% vs 12%; p=0.033); women (79% vs 38%; p=0.007); older patients (average 57.0 vs 68.4 years; p=0.001). These risk factors were used in a score (0-4) to evaluate the risk in each case. The patients with higher risk scores had greater subsidence (p<0.001). Scores ≥2 were predictive of subsidence with 92% sensitivity and 72% specificity. Conclusions: It was possible to correlate the degree of subsidence in standalone LLIF procedures using demographic (age and gender) and pathological (spondylolisthesis and scoliosis) data. With a score based on risk factors and considering any score <2, the probability of non-occurrence of subsidence following standalone LLIF (negative predictive value) was 98%. (93% vs. 18%; p < 0,001); escoliose (31% vs. 12%; p = 0,033); mulheres (79% vs. 38%; p = 0,007); pacientes idosos (média de 57,0 vs. 68,4 anos; p = 0,001 (93% vs. 18%, p <0,001); escoliosis (31% vs. 12%, p = 0,033); mujeres (79% vs. 38%, p = 0,007); ancianos (media de 57,0 a 68,4 años; p = 0,001

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Subsidence of Polyetheretherketone Intervertebral Cages in Minimally Invasive Lateral Retroperitoneal Transpsoas Lumbar Interbody Fusion

Cited by 230 publications

References 29 publications

Is the Lateral Transpsoas Approach Feasible for the Treatment of Adult Degenerative Scoliosis?

Is the Lateral Transpsoas Approach Feasible for the Treatment of Adult Degenerative Scoliosis?

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

In Which Patients Is It Possible to Perform Standalone Lateral Lumbar Interbody Fusion Without Cage Subsidence?

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