Comparative Study of Radiographic Disc Height Changes Using Two Different Interbody Devices for Transforaminal Lumbar Interbody Fusion

Matsumura, Akira; Taneichi, Hiroshi; Suda, Kota; Kajino, Tomomichi; Moridaira, Hiroshi; Kaneda, Kiyoshi

doi:10.1097/01.brs.0000244593.86975.27

Cited by 18 publications

(11 citation statements)

References 29 publications

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“…Eighteen studies reported results stratified for different treatment regimens and/or different diagnoses. 27,32,37,38,42,[44][45][46][47][48][52][53][54][55][56][57][58][59] The respective study groups were analyzed separately in the quantitative analysis (total number of study groups ¼ 49), and the number of included study groups ranged from 5 to 31, depending on the variable of interest ( Table 6).…”

Section: Discussionmentioning

confidence: 99%

Screw-Related Complications After Instrumentation of the Osteoporotic Spine: A Systematic Literature Review With Meta-Analysis

Rometsch

Spruit²,

Zigler

et al. 2019

Global Spine Journal

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Study Design: Systematic literature review with meta-analysis. Objective: Osteoporosis is common in elderly patients, who frequently suffer from spinal fractures or degenerative diseases and often require surgical treatment with spinal instrumentation. Diminished bone quality impairs primary screw purchase, which may lead to loosening and its sequelae, in the worst case, revision surgery. Information about the incidence of spinal instrumentation-related complications in osteoporotic patients is currently limited to individual reports. We conducted a systematic literature review with the aim of quantifying the incidence of screw loosening in osteoporotic spines. Methods: Publications on spinal instrumentation of osteoporotic patients reporting screw-related complications were identified in 3 databases. Data on screw loosening and other local complications was collected. Pooled risks of experiencing such complications were estimated with random effects models. Risk of bias in the individual studies was assessed with an adapted McHarm Scale. Results: From 1831 initial matches, 32 were eligible and 19 reported screw loosening rates. Studies were heterogeneous concerning procedures performed and risk of bias. Screw loosening incidences were variable with a pooled risk of 22.5% (95% CI 10.8%-36.6%, 95% prediction interval [PI] 0%-81.2%) in reports on nonaugmented screws and 2.2% (95% CI 0.0%-7.2%, 95% PI 0%-25.1%) in reports on augmented screws. Conclusions: The findings of this meta-analysis suggest that screw loosening incidences may be considerably higher in osteoporotic spines than with normal bone mineral density. Screw augmentation may reduce loosening rates; however, this requires confirmation through clinical studies. Standardized reporting of prespecified complications should be enforced by publishers.

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Section: Discussionmentioning

confidence: 99%

Screw-Related Complications After Instrumentation of the Osteoporotic Spine: A Systematic Literature Review With Meta-Analysis

Rometsch

Spruit²,

Zigler

et al. 2019

Global Spine Journal

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“…5,9 Posterior approaches for interbody fusion (TLIF and PLIF) use 1 or 2 small intervertebral cages, typically covering between 13% and 25% of the endplate, respectively, and rarely covering the stronger posterior and lateral borders of the apophyseal ring. 9,19 Although interbody cage subsidence is common with posterior approaches (up to 22% 25,26 ), it is less clinically and radiographically relevant, because direct decompressions are used and alignment is corrected by compressive posterior instrumentation.…”

Section: Discussionmentioning

confidence: 99%

Assessment and classification of subsidence after lateral interbody fusion using serial computed tomography

Malham

Parker²,

Blecher

et al. 2015

SPI

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OBJECT Intervertebral cage settling during bone remodeling after lumbar lateral interbody fusion (LIF) is a common occurrence during the normal healing process. Progression of this settling with endplate collapse is defined as subsidence. The purposes of this study were to 1) assess the rate of subsidence after minimally invasive (MIS) LIF by CT, 2) distinguish between early cage subsidence (ECS) and delayed cage subsidence (DCS), 3) propose a descriptive method for classifying the types of subsidence, and 4) discuss techniques for mitigating the risk of subsidence after MIS LIF. METHODS A total of 128 consecutive patients (with 178 treated levels in total) underwent MIS LIF performed by a single surgeon. The subsidence was deemed to be ECS if it was evident on postoperative Day 2 CT images and was therefore the result of an intraoperative vertebral endplate injury and deemed DCS if it was detected on subsequent CT scans (≥ 6 months postoperatively). Endplate breaches were categorized as caudal (superior endplate) and/or cranial (inferior endplate), and as ipsilateral, contralateral, or bilateral with respect to the side of cage insertion. Subsidence seen in CT images (radiographic subsidence) was measured from the vertebral endplate to the caudal or cranial margin of the cage (in millimeters). Patient-reported outcome measures included visual analog scale, Oswestry Disability Index, and 36-Item Short Form Health Survey physical and mental component summary scores. RESULTS Four patients had ECS in a total of 4 levels. The radiographic subsidence (DCS) rates were 10% (13 of 128 patients) and 8% (14 of 178 levels), with 3% of patients (4 of 128) exhibiting clinical subsidence. In the DCS levels, 3 types of subsidence were evident on coronal and sagittal CT scans: Type 1, caudal contralateral, in 14% (2 of 14), Type 2, caudal bilateral with anterior cage tilt, in 64% (9 of 14), and Type 3, both endplates bilaterally, in 21% (3 of 14). The mean subsidence in the DCS levels was 3.2 mm. There was no significant difference between the numbers of patients in the subsidence (DCS) and no-subsidence groups who received clinical benefit from the surgical procedure, based on the minimum clinically important difference (p > 0.05). There was a significant difference between the fusion rates at 6 months (p = 0.0195); however, by 12 months, the difference was not significant (p = 0.2049). CONCLUSIONS The authors distinguished between ECS and DCS. Radiographic subsidence (DCS) was categorized using descriptors for the location and severity of the subsidence. Neither interbody fusion rates nor clinical outcomes were affected by radiographic subsidence. To protect patients from subsidence after MIS LIF, the surgeon needs to take care with the caudal endplate during cage insertion. If a caudal bilateral (Type 2) endplate breach is detected, supplemental posterior fixation to arrest progression and facilitate fusion is recommended.

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“…Operative methods have been recently introduced, such as artificial disc replacement, that induce bone fusion through interbody fusion in the situation of restoring the intervertebral disc space while maintaining the segmental movement [4-6]. Nevertheless, there are no studies from Korea or other countries on measuring the lumbar intervertebral disc space by applying magnetic resonance imaging, and only the measurements using simple radiographs are available for the reference values of the distance of the intervertebral disc space of normal Korean adults.…”

Section: Introductionmentioning

confidence: 99%

Measurement of the Normal Lumbar Intervertebral Disc Space using Magnetic Resonance Imaging

et al. 2010

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Study DesignThis is a retrospective study.PurposeWe wanted to measure the distance of the normal intervetebral disc space of Koreans.Overview of the LiteratureFor judging the distance of the normal intervertebral disc space of Koreans, we studied young adults who didn't have degenerative spinal change to determine the distance of the normal intervertebral disc space of each lumbar vertebral segment, and we did so by performing magnetic resonance imaging (MRI).MethodsWe studied a total of 178 outpatients who had low back pain and they underwent lumbar MRI. There were 138 males and 40 females, and their average age was 20.7 years (range, 15 to 25 years). On MRI, the segments with observed Modic change or other abnormalities were excluded from this investigation. To improvement the accuracy of measurement, two spine specialists measured the distances 2 times, and we calculated the mean value. We used paired t-tests for statistical analysis.ResultsIn the total 178 patients, the average distance of intervertebral space from the 1st to the 2nd lumbar vertebrae was 24.83% (range, 18 to 32%), that from the 2nd to the 3rd was 26.92% (range, 19 to 40%), that from the 3rd to 4th was 28.88% (range, 19 to 41%), that from the 4th to 5th was 29.60% (range, 21 to 43%) and that from the 5th lumbar vertebra to the 1st sacrum was 27.52% (range, 19 to 38%).ConclusionsIn this study, we expect that knowing the normal distance of the lumbar intervertebral space of Koreans can be helpful for surgical reconstruction to treat many lumbar spine diseases, to predict the appropriate size of the devices inserted in the intervertebral space and to produce proper devices for Koreans.

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Comparative Study of Radiographic Disc Height Changes Using Two Different Interbody Devices for Transforaminal Lumbar Interbody Fusion

Cited by 18 publications

References 29 publications

Screw-Related Complications After Instrumentation of the Osteoporotic Spine: A Systematic Literature Review With Meta-Analysis

Screw-Related Complications After Instrumentation of the Osteoporotic Spine: A Systematic Literature Review With Meta-Analysis

Assessment and classification of subsidence after lateral interbody fusion using serial computed tomography

Measurement of the Normal Lumbar Intervertebral Disc Space using Magnetic Resonance Imaging

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