Effect of interbody fusion cage on clinical and radiological outcome of surgery in L4–L5 lumbar degenerative spondylolisthesis

Omidi-Kashani, Farzad; Jalilian, R.; Golhasani-Keshtan, Farideh

doi:10.21037/jss.2018.03.17

Cited by 6 publications

(4 citation statements)

References 24 publications

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“…Additionally, the study of Khan et al [27] reported that TLIF for DS clinical assessment was based on VAS, with the mean preoperative VAS for back pain improving to 2 and the mean preoperative VAS for leg pain improving to 1 (0-5). Another study by Omidi-Kashani et al [28] found that, mean VAS (leg or back) improvement was comparable between the two groups, and cage application was unable to demonstrate a greater therapeutic impact. Although the TLIF group had better intervertebral union and loss of reduction, these changes were not statistically significant.…”

Section: Discussionmentioning

confidence: 92%

Comparative Study of Transpedicular Fixation with and without Interbody Fusion Cage in Management of L4-L5 Lumbar Degenerative Spondylolisthesis

2024

The Egyptian Journal of Hospital Medicine

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Background: Lumbar degenerative spondylolisthesis (LDS) is a clinically symptomatic degenerative slippage of a lumbar vertebra relative to the neighboring vertebra below. Objective: T h i s s t u d y a i m e d t o compare clinical and radiological outcomes following management of L4-L5 LDS with and without interbody fusion cage. Patients and methods: This prospective study included 40 patients with degenerative spondylolisthesis who were surgically treated by transpedicular screws with and without interbody fusion cage at the Neurosurgery Department, Faculty of Medicine, Menoufia University over a 3-year period from January 2018 to 21 January 2021.The patients were divided into two equal groups: Group A that involved patients treated by transpedicular screws only, and group B that included patients treated by transpedicular screws and inter body fusion cage. Results: Post-operative follow-up fusion was significantly higher among group B (17.01 ± 0.06) than a m o n g group A (15.01 ± 0.06) with a mean difference of 11.75% (p<0.001). On contrast, pseudoarthrosis and slip percentage were significantly increased among group A than among group B with a mean difference of 66.44% and 118%, respectively (p<0.001). VAS (low back pain and leg pain) significantly improved post-treatment compared to pretreatment among group A (p<0.001) where it was decreased from 8.01 ± 0.06 and 7.01 ± 0.06 to1.51 ± 0.06 and1.61 ± 0.06, with a mean change of 5.57 ± 2.31, (95%CI, 4.49-6.65); and 4.64 ± 1.88 (95%CI, 3.77-5.52) respectively, (p<0.001). Also, among group B, VAS (low back pain and leg pain) significantly improved post-treatment compared to pretreatment (p<0.001) where it was decreased from 7.01 ± 0.06 and 9.01 ± 0.06 to 2.01 ± 0.06 and 2.41 ± 0.06 respectively with a mean change of 4.84 ± 1.14 (95% CI, 4.32-5.36), and 6.21 ± 1.55 (95% CI, 5.50-6.91) respectively (p<0.001). Conclusion: Transpedicular fixation by screws with and without interbody fusion produces the same outcomes in terms of postoperative clinical improvement and patient satisfaction.

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Section: Discussionmentioning

confidence: 92%

Comparative Study of Transpedicular Fixation with and without Interbody Fusion Cage in Management of L4-L5 Lumbar Degenerative Spondylolisthesis

2024

The Egyptian Journal of Hospital Medicine

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“…Yet, no significant difference was observed in the Oswestry Disability Index, VAS, fusion rate, and the loss of the correction between the two study groups. The authors concluded that using an interbody fusion cage did not significantly improve the radiologic and clinical outcomes of surgery in SL patients [14].…”

Section: Discussionmentioning

confidence: 95%

Improvement of Spinopelvic Parameters Following the Surgical Treatment of Spondylolisthesis Using Interbody Fusion Cage

Ghandhari

Nikouei

Chehrassan

et al. 2020

J. Res. Orthop. Sci.

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Background: There is no consensus regarding the clinical benefit of interbody fusion cage in the treatment of Spondylolisthesis (SL). This study aimed to evaluate the effect of posterolateral fusion combined with interbody fusion cage on the spinopelvic parameters and the pain level of the patients. Objectives: Role of interbody fusion in the treatment of spondylolisthesis Methods: This prospective study included 40 SL patients who underwent surgery following the failure of conservative management. The Meyerding classification was used to grade SL. Also, the visual analog scale was used to measure the level of pain, before and after the operation. Spinopelvic parameters included total kyphosis, sagittal vertebral axis, pelvic tilt, pelvic incidence, and lumbar lordosis. Results: The Mean±SD age of the patients was of 53.4±11.6 years. In four patients (10%), SL occurred at two levels. Besides, the etiology was degenerative in 21 cases (52.5%) and isthmic in 19 cases (47.5%). The grade I, II, and III of SL were detected respectively in 17, 17, and 6 cases (42.5%, 42.5%, and 15%, respectively). The Mean±SD preoperative value of the sagittal vertebral axis was 43.1±33.1 mm, which improved to 24.8±22.3 mm after the surgery (P<0.001). Also, the Mean±SD preoperative value of the pelvic tilt significantly improved from 19.2±10º to 17±9.1º (P=0.049). Moreover, the Mean±SD score of the visual analog scale improved from 9.1±0.8 to 2.8±1.2 (P<0.001). The clinical and spinopelvic parameters greatly improved in patients with degenerative SLs, single-level SLs, and the lower grades of SL. Conclusion: Posterolateral fusion combined with interbody fusion cage improves both the clinical and spinopelvic parameters of SL patients and could be suggested as the treatment of choice for these patients.

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“…Most previous studies have focused on the relationship between cage parameters and the lumbar sagittal sequence, such as the intervertebral space height and the lordosis angle. Omidi-Kashani et al suggest that after fusion surgery at the L4-L5 level, the intervertebral fusion cage may not significantly improve the radiological and clinical outcomes but may be related to more complications and morbidity (18). Furthermore, Castellvi et al found that the best cage position for acquiring stability is near the sagittal plane's midline (19).…”

Section: Discussionmentioning

confidence: 99%

Do the positioning variables of the cage contribute to adjacent facet joint degeneration? Radiological and clinical analysis following intervertebral fusion

Li¹,

Zhan²,

Xi³

et al. 2021

Ann Transl Med

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Background: Compared to other risk factors, adjacent facet joint degeneration (AFD) is the main contributor to adjacent segment disease (ASD). The interbody cage may be a potential indirect risk of AFD.This study investigated the correlations among the lumbar sagittal balance parameters, the inter-body cage's intraoperative positioning variables, and adjacent facet joint degeneration following the transforaminal lumbar interbody fusion (TLIF) technique.Methods: Patients who accepted single-level TLIF for symptomatic lumbar degenerative disease and were followed up for at least six months were enrolled in this study. According to the inclusive and exclusive criteria, 93 patients were included (44 males and 49 females). X-ray and computed tomography (CT) images were obtained before and six months after surgery. The vertebral contour and the center of the marker mass in the cage were calculated using a geometric algorithm. Orthopedic surgeons measured the disc height, lordosis angle, and facet joint degeneration. Patient-reported outcomes, including the Oswestry Disability Index (ODI) and the visual analog scale (VAS), were used to assess the clinical outcomes. The Student's t-test, Wilcoxon rank-sum test, and Chi-square test were used for the statistical analyses. Results:The average age was 53.7 years old (range, 27-84 years). The average functional disability outcome assessed by the ODI was 61.2, and the average back and leg pain assessed by the VAS was 6.2 and 6.9, respectively. The patients were categorized into a normal group and an abnormal (AFD) group according to whether the facet joint degeneration was aggravated. The abnormal group had a higher back pain VAS score (P=0.031) and lower sagittal vertical position (P=0.027). The other parameters were similar at baseline (P>0.05). The cage's sagittal vertical position decreased significantly with AFD aggravation (OR, 0.737; 95% CI, 0.561-0.969). Conclusions:In patients with AFD aggravation, the preoperative VAS and postoperative ODI scores were significantly higher. The cage position parameters were related to AFD. A lower cage center was associated with a greater incidence of AFD.

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Effect of interbody fusion cage on clinical and radiological outcome of surgery in L4–L5 lumbar degenerative spondylolisthesis

Abstract: In the surgical treatment of the patients with L4-L5 LDS, interbody fusion cage probably does not significantly improve the radiologic and clinical outcomes and may also be associated with more complication and morbidity.

Cited by 6 publications

References 24 publications

Comparative Study of Transpedicular Fixation with and without Interbody Fusion Cage in Management of L4-L5 Lumbar Degenerative Spondylolisthesis

Comparative Study of Transpedicular Fixation with and without Interbody Fusion Cage in Management of L4-L5 Lumbar Degenerative Spondylolisthesis

Improvement of Spinopelvic Parameters Following the Surgical Treatment of Spondylolisthesis Using Interbody Fusion Cage

Do the positioning variables of the cage contribute to adjacent facet joint degeneration? Radiological and clinical analysis following intervertebral fusion

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