Analysis of a Unilateral Bridging Cage for Lumbar Interbody Fusion: 2-Year Clinical Results and Fusion Rate with a Focus on Subsidence

Höh, Nicolas H. von der; Villa, Tomaso; Galbusera, Fabio; Voelker, Anna; Spiegl, U; Jarvers, Jan-Sven; Heyde, Christoph E.

doi:10.1016/j.wneu.2018.04.195

Cited by 13 publications

(11 citation statements)

References 26 publications

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“…Furthermore, the Fisher's exact test show a significant difference (p = 0.0216) of the bony fusion of the patient group treated with cage implantation and autologous pelvic bone graft, i.e., the cage implants showed a better bony fusion rate than the autologous pelvic bone grafts as determined by a complete bony fusion in the absence of signs for bone loosening. Based on this judgement [11], the minimum fusion time was estimated to be 3.3 months (±3.2) on average in the autologous pelvic bone grafts group and about 4.1 months (±2.8) in the cage group (see Figure 2b). The maximum fusion time observed was lower in the autologous The linear model performed to predict length of stay with type of intervention, age, and localisation showed a significant difference for age (p < 0.001).…”

Section: Resultsmentioning

confidence: 99%

“…These radiological controls included an antero-posterior view of the spine with an additional lateral projection and they were evaluated by two experienced spine surgeons. The status of the patients was considered stable, and bones were judged as probably fused, when the following radiological signs were detectable: (1) loosening signs such as hypodense areas around the implant, bone lysis, hypertrophic callus, or delayed fracture healing were absent after 12 months [ 10 ]; (2) detectable callus formation when bridging bone connecting the adjacent vertebral bodies was detected either through or around the implants and no radiolucency was seen, (3) visible bridging trabecular bone either crossing the cage or surrounding it, which were detected on anterior–posterior and lateral views of the radiographs [ 11 ]; (4) lack of substantial sclerotic changes in the recipient bone bed; and (5) vertebral body translation of <3 mm on lateral radiographs [ 11 ]. If these radiological signs were absent, it was classified as non-fused (see Figure 1 e,f).…”

Section: Methodsmentioning

confidence: 99%

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Cage or Pelvic Graft—Study on Bony Fusion of the Ventral Thoracic and Lumbar Spine in Traumatic Vertebral Fractures

et al. 2021

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Background and Objectives: Stabilization of the spine by cage implantation or autologous pelvic bone graft are surgical methods for the treatment of traumatic spine fractures. These methods serve to stably re-adjust the spine and to prevent late detrimental effects such as pain or increasing kyphosis. They both involve ventral interventions using interbody fusion to replace the intervertebral disc space between the vertebral bodies either by cages or autologous pelvic bone grafts. We examined which of these methods serves the patients better in terms of bone fusion and the long-term clinical outcome. Materials and Methods: Forty-six patients with traumatic fractures (12 cages; mean age: 54.08/34 pelvic bone grafts; mean age: 42.18) who received an anterior fusion in the thoracic or lumbar spine were included in the study. Postoperative X-ray images were evaluated, and fusion of the stabilized segment was inspected by two experienced spine surgeons. The time to discharge from hospital and gender differences were evaluated. Results: There was a significant difference of the bone fusion rate of patients with autologous pelvic bone grafts in favor of cage implantation (p = 0.0216). Also, the stationary phase of patients who received cage implantations was clearly shorter (17.50 days vs. 23.85 days; p = 0.0089). In addition, we observed a significant gender difference with respect to the bony fusion rate in favor of females treated with cage implantations (p < 0.0001). Conclusions: Cage implantations after spinal fractures result in better bony fusion rates as compared to autologous pelvic bone grafts and a shorter stay of the patients in the hospital. Thus, we conclude that cage implantations rather than autologous pelvic bone grafts should be the preferred surgical treatment for stabilizing the spine after fracture.

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Section: Resultsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Cage or Pelvic Graft—Study on Bony Fusion of the Ventral Thoracic and Lumbar Spine in Traumatic Vertebral Fractures

et al. 2021

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“…Its safety and effectiveness have also been confirmed in previous studies, because singlecage TLIF could achieve the same biomechanical stability similar to that of the double-cage TLIF. 32,33 Furthermore, Lee et al 34 reported no significant difference in clinical and radiographic outcomes between patients who underwent single-cage PLIF and double-cage PLIF for spinal degenerative diseases. In addition, Kroppenstedt et al 35 verified that there was no significant difference between the two groups regarding the maintenance of spinal stability and cage subsidence after 8 years of follow-up.…”

Section: Key Technical Notes and Theoretical Advantages Of Screw Retr...mentioning

confidence: 99%

Radiographic Analysis of Pedicle Screw Retractor‐Assisted Transforaminal Lumbar Interbody Fusion for Single‐Segment Spondylolisthesis in Adults: A Retrospective Study and Technical Note

Xie

Ouyang

Zhang

2022

Orthopaedic Surgery

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Objectives The objective of this study was to introduce a retractor that can be temporarily installed on unilateral pedicle screws to achieve distraction‐reduction and nerve root protection, and to analyze the efficacy and safety of retractor‐assisted transforaminal lumbar interbody fusion (TLIF) in the treatment of lumbar spondylolisthesis. Methods This was a retrospective study of 125 patients who underwent retractor‐assisted TLIF for single‐segment spondylolisthesis from November 2017 to February 2021. Based on morphology, patients were divided into degenerative (N = 66) and isthmic groups (N = 59). Differences in demographics and preoperative characteristics between the groups were analyzed using the independent samples t‐test and χ2 test. Changes in radiographic parameters (disc height, foramen height, spondylolisthesis degree, slippage length, and segmental lordosis) before and after surgery were compared using the paired samples t‐test. Logistic regression analysis was performed to analyze the relationship between facet joint angle (FJA) and degenerative lumbar spondylolisthesis (DLS). Results Unilateral screw retractor‐assisted TLIF significantly corrected spondylolisthesis and improved disc height and segmental lordosis (p < 0.05). There was no significant difference in foramen height between the two sides before and after operation (pre: 15.81 ± 3.58 mm vs 15.69 ± 3.68 mm, p = 0.599; post: 18.65 ± 2.31 mm vs 18.74 ± 2.26 mm, p = 0.516). The degree of spondylolisthesis in the DLS group before surgery was significantly lower than that in the isthmic spondylolisthesis group (17.70 ± 5.62% vs 25.18 ± 9.73%, p < 0.001), whereas a similar degree of correction could be achieved after surgery (5.91 ± 3.12% vs 7.16 ± 5.69%, p = 0.135). FJAs from L3/4 to L5/S1 were significantly smaller in patients with DLS than those in with isthmic spondylolisthesis (p < 0.05). Patients with facet sagittalization were more likely to have DLS (β: −0.101, odds ratio [OR]:0.904, 95% confidence interval [CI]: 0.874–0.934, p < 0.001), while the cut‐off FJA of L4/5 for predicting L4 spondylolisthesis was 53.19. Conclusions Pedicle screw retractor‐assisted TLIF is effective and safe in treating both degenerative and isthmic lumbar spondylolisthesis. The unilateral retractor has the capacity to maintain the disc height achieved by paddle distractors, which optimizes the nerve protection and distractor placement. Patients with an FJA on L4/5 <53.19 were more likely to have DLS.

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“…The main key factor affecting cage subsidence is the cage size. Bigger cage surface area in contact with the endplate resulted in less subsidence since it reduces endplate stress [87]- [90].…”

Section: Subsidencementioning

confidence: 99%

“…See Table 3, for cages example with dimensions, for each surgery procedures. Another crucial aspect is the placement of the implant, since the endplate is weaker in the centre [87]. Studies evaluating different implants, on cadaveric spinal units, during cyclic compressive loads, suggested that regardless of the cage type, placing the implant on the peripheral subchondral bone is one of the most effective methods to prevent the cage from penetrating the vertebral body interphase [91], [92].…”

Section: Subsidencementioning

confidence: 99%

Characterization and Design Optimization of Periodic Cellular Solids for Optimal Bone Ingrowth in Osseointegration Implants.

Parisien¹

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Post-operative complications of spinal lumbar fusion include cage subsidence and nonunion. The lack or delayed osseointegration of the fusion cage may be one of the problems resulting in poor outcomes. The use of micro-architectured truss-like lattice materials to improve implant osseointegration is getting more attention beyond spinal fusion. Therefore, the main goal of this research is to define the optimal lattice microscopic parameters to maximize bone ingrowth, for fusion spinal cages. A tool based on previous mechano-regulatory models is implemented numerically, to determine the fraction of void space within a structure that receives optimal stimulation for bone ingrowth. The model was used to replicate previous in silico and in vivo results and showed very good agreement when comparing the different lattice topologies, unit cell orientation, microscopic strut cross-section shape as well as strut size. Characterization of the performance of lattice materials, relevant for osseointegration, is conducted for fourteen unit cell topologies, with ten relative densities, under four axial loadings. Results suggested that Diamond, X-Shape, Tesseract and Rhombic Dodecahedron with horizontal orientation provide the best biomechanical environment for cells to grow and form bone tissue. Pressure (MPa) Circle Replication Circle Replication Circle Rodriguez et al. Circle Rodriguez et al.

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Analysis of a Unilateral Bridging Cage for Lumbar Interbody Fusion: 2-Year Clinical Results and Fusion Rate with a Focus on Subsidence

Cited by 13 publications

References 26 publications

Cage or Pelvic Graft—Study on Bony Fusion of the Ventral Thoracic and Lumbar Spine in Traumatic Vertebral Fractures

Cage or Pelvic Graft—Study on Bony Fusion of the Ventral Thoracic and Lumbar Spine in Traumatic Vertebral Fractures

Radiographic Analysis of Pedicle Screw Retractor‐Assisted Transforaminal Lumbar Interbody Fusion for Single‐Segment Spondylolisthesis in Adults: A Retrospective Study and Technical Note

Characterization and Design Optimization of Periodic Cellular Solids for Optimal Bone Ingrowth in Osseointegration Implants.

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