Vertebral Endplate Cyst Formation in Relation to Properties of Interbody Cages

Sasaki, Masaru; Umegaki, Masao; Fukunaga, Takanori; Hijikata, Yasukazu; Banba, Y; Matsumoto, Katsumi; Miyao, Yasuyoshi

doi:10.14245/ns.2040498.249

Cited by 4 publications

(2 citation statements)

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“…Recently, it has been reported that VECF after lumbar interbody fusion using a cage in the early postoperative period may be a predictor of pseudoarthrosis or non-fusion [ 39 ], and the relationship between VECF and non-fusion has been investigated for different types of interbody cages, including polyetheretherketone (PEEK), titanium, titanium-coated PEEK, and porous tantalum; however, no studies have investigated this relationship in patients treated using Ag-HA cages [ 39 , 40 ]. In the present study, cage subsidence occurred in three cases (5.9%) at 12 months after surgery.…”

Section: Discussionmentioning

confidence: 99%

“…Regarding the suitability of VECF as an indicator of bone fusion, at 12 months postoperatively, we noted VECF incidences of 13.7% to 60% in the PEEK cage group, 0–17.3% in the titanium cage group, and 21.6% in the Ag-HA cage group. Thus, the PEEK cage tends to be associated with a higher incidence of VECF [ 39 , 40 ], which seems true for the Ag-HA and titanium cages. The respective rates of VECF and bone fusion were 29% and 88% at 6 months after surgery and 22% and 91% at 12 months after surgery, respectively.…”

Section: Discussionmentioning

confidence: 99%

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First clinical experience with posterior lumbar interbody fusion using a thermal-sprayed silver-containing hydroxyapatite-coated cage

Morimoto

Tsukamoto

Aita³

et al. 2023

J Orthop Surg Res

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Background To investigate the possibility of silver (Ag)-induced adverse events and the degree of bone fusion in posterior lumbar interbody fusion surgery using an Ag-containing hydroxyapatite (HA) lumbar interbody cage. Methods An Ag-HA cage consisting of highly osteoconductive HA interfused with Ag was developed, and we applied it clinically at three university-affiliated hospitals from April 2020 to December 2020. During the 12-month postoperative observation period, Ag-related adverse events, neuropathy, and postoperative complications were investigated as indicators of safety, while clinical improvement and the fusion status were investigated as indicators of efficacy. Clinical improvement was defined as improvement beyond the minimum clinically important difference (MCID) in the numerical rating scale (NRS; 1.6) for low back and lower limb pain and the Oswestry Disability Index (ODI; 12.8). Results We performed lumbar interbody fusion using an Ag-HA cage for 48 patients (female, n = 25; mean age, 67.5 years). The mean preoperative NRS was 6.4 (standard deviation, 1.9), while the mean preoperative ODI was 44 [12]. No adverse effects (i.e., argyria) were identified during the 12-month observation period. Surgical site infection occurred in one case, although the implant was preserved via immediate debridement. In total, 39 (81%) participants showed clinical improvement beyond MCID for both NRS and ODI. Bone fusion was achieved at 45 levels (88%) at 6 months and 48 levels (91%) at 12 months postoperatively. Conclusions The results of this study suggest that Ag-HA cages can be safely used in spinal fusion procedures and have the potential to prevent postoperative infections, prevent deterioration of the quality of life, and result in favorable outcomes. Larger-scale and longer-term follow-up studies will be required to corroborate these conclusions. Trial registration UMIN 000039964 (date: April 01, 2020).

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

First clinical experience with posterior lumbar interbody fusion using a thermal-sprayed silver-containing hydroxyapatite-coated cage

Morimoto

Tsukamoto

Aita³

et al. 2023

J Orthop Surg Res

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The Effectiveness of Tritanium Cages in Preventing Osteolytic Vertebral Endplate Cysts After Lumbar Interbody Fusion

Takeuchi,

Inoue,

Takahashi

et al. 2024

World Neurosurgery

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Vertebral Endplate Cavities with Titanium Cages in Posterior Lumbar Interbody Fusion

Elfiky,

El Mansy,

Stienen

et al. 2024

J Neurol Surg A Cent Eur Neurosurg

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Background: Vertebral endplate cavities (VEC) have been reported with the use of Ti cages. Only few articles have recently demonstrated unfavorable radiographic changes in the form of cysts or cavities which may predispose to nonunion. Methods: The aim was to assess the prevalence of VEC in posterior lumbar interbody fusion (PLIF) using Titanium (Ti) cages, and to estimate their impact on fusion. The term “cavity” was used to describe the endplate changes. CT analysis of the VEC and fusion status following PLIFs with Ti cages was conducted by two observers. VEC were assessed according to the size, multiplicity, location, and presence of sclerosis. Results: 42 consecutive patients with surgeries conducted on 52 levels were enrolled. There were 20 males and 22 females. The mean age was 43.6 ±10.89 years. The mean follow-up was 20.85±8.49 months. Definite union was seen in 48 levels (92.3%) by observer 1 and in 40 levels (76.9%) by observer 2. The strength of agreement was moderate. The presence of VEC was observed in 9 levels (17.3%) by observer 1 and in 12 levels (23.1%) by observer 2. The strength of agreement was moderate. The majority of VEC in the endplates were <5mm. The strength of agreement was high. The strength of agreement for location and multiplicity were moderate. The VEC was significantly correlated with the fusion status. Conclusions: Our study confirmed that VEC were observed following Ti cage placement after PLIF procedures. They tend to be small and might be associated with non-union. Furthermore, it reflected the limited inter-rater reliability of the assessment of both the fusion status and VEC morphology after Ti PLIF cage placement.

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Vertebral Endplate Cyst Formation in Relation to Properties of Interbody Cages

Cited by 4 publications

References 18 publications

First clinical experience with posterior lumbar interbody fusion using a thermal-sprayed silver-containing hydroxyapatite-coated cage

First clinical experience with posterior lumbar interbody fusion using a thermal-sprayed silver-containing hydroxyapatite-coated cage

The Effectiveness of Tritanium Cages in Preventing Osteolytic Vertebral Endplate Cysts After Lumbar Interbody Fusion

Vertebral Endplate Cavities with Titanium Cages in Posterior Lumbar Interbody Fusion

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