Endplate volumetric bone mineral density is a predictor for cage subsidence following lateral lumbar interbody fusion: a risk factor analysis

Jones, Conor; Okano, Ichiro; Salzmann, Stephan N.; Reisener, Marie–Jacqueline; Chiapparelli, Erika; Shue, Jennifer; Sama, Andrew A.; Cammisa, Frank P.; Girardi, Federico P.; Hughes, Alexander P.

doi:10.1016/j.spinee.2021.02.021

Cited by 35 publications

(19 citation statements)

References 40 publications

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“…There were 15 studies that discussed cage subsidence after LIF [ 20 , 31 , 32 , 34 , 36 , 37 , 40 , 44 , 45 , 49 – 53 , 55 ], with qualities of moderate ( n = 11) and high ( n = 4). For the 2,558 cages pooled across these studies, 705 cages had subsidence (27.6%).…”

Section: Resultsmentioning

confidence: 99%

“…Thresholds for identification of subsidence varied between 2 and 4 mm across studies [ 20 , 31 , 34 , 37 , 40 , 49 , 51 , 53 , 55 ]. Three studies classified subsidence into four grades based on the loss of disc height after LIF (Grade 0: a loss of 0–24% in disc height; Grade I: 25–49%; Grade II: 50–74%; Grade III: 75–100%), with a loss in disc height of 24% indicative of considerable cage subsidence [ 36 , 44 , 52 ].…”

Section: Resultsmentioning

confidence: 99%

“…All articles except four [ 41 , 42 , 45 , 50 ] mentioned the material details of the spinal cages involved in their studies (qualities: low/moderate/high, 2/18/5). Of the 13 studies that evaluated cage subsidence, there were 2236 cages and the proportions of cage material were as follows: titanium, 174 (7.8%); porous titanium, 46 (2.1%); and PEEK, 2016 (90.2%) [ 20 , 31 , 32 , 34 , 36 , 37 , 40 , 44 , 49 , 51 – 53 , 55 ]. There were 678 subsided cages with the following materials: titanium, 18 (2.7%); porous titanium, 20 (2.9%); and PEEK, 640 (94.4%).…”

Section: Resultsmentioning

confidence: 99%

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Influence of the geometric and material properties of lumbar endplate on lumbar interbody fusion failure: a systematic review

Robinson

Ackland

et al. 2022

J Orthop Surg Res

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Background Lumbar interbody fusion (LIF) is an established surgical intervention for patients with leg and back pain secondary to disc herniation or degeneration. Interbody fusion involves removal of the herniated or degenerated disc and insertion of interbody devices with bone grafts into the remaining cavity. Extensive research has been conducted on operative complications such as a failure of fusion or non-union of the vertebral bodies. Multiple factors including surgical, implant, and patient factors influencing the rate of complications have been identified. Patient factors include age, sex, osteoporosis, and patient anatomy. Complications can also be influenced by the interbody cage design. The geometry of the bony endplates as well as their corresponding material properties guides the design of interbody cages, which vary considerably across patients with spinal disorders. However, studies on the effects of such variations on the rate of complications are limited. Therefore, this study aimed to perform a systematic review of lumbar endplate geometry and material property factors in LIF failure. Methods Search keywords included ‘factor/cause for spinal fusion failure/cage subsidence/cage migration/non-union’, ‘lumbar’, and ‘interbody’ in electronic databases PubMed and Scopus with no limits on year of publication. Results In total, 1341 articles were reviewed, and 29 articles were deemed suitable for inclusion. Adverse events after LIF, such as cage subsidence, cage migration, and non-union, resulted in fusion failure; hence, risk factors for adverse events after LIF, notably those associated with lumbar endplate geometry and material properties, were also associated with fusion failure. Those risk factors were associated with shape, concavity, bone mineral density and stiffness of endplate, segmental disc angle, and intervertebral disc height. Conclusions This review demonstrated that decreased contact areas between the cage and endplate, thin and weak bony endplate as well as spinal diseases such as spondylolisthesis and osteoporosis are important causes of adverse events after LIF. These findings will facilitate the selection and design of LIF cages, including customised implants based on patient endplate properties.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Influence of the geometric and material properties of lumbar endplate on lumbar interbody fusion failure: a systematic review

Robinson

Ackland

et al. 2022

J Orthop Surg Res

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“…Osteoporosis is one of the important risk factors of cage subsidence previously reported. Previous studies have shown that bone mineral density is related to the stable failure load of endplate and cage [13,14]. Oh et al found that the correlation between BMD and subsidence was very weak, and patients with score < −3:0 had an increased risk of subsidence [15].…”

Section: Discussionmentioning

confidence: 99%

Comparison of Long-Term Efficacy of MIS-TLIF Intraoperative Implants in Patients with Osteoporosis

Liu

et al. 2022

Computational and Mathematical Methods in Medicine

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Osteoporosis and degenerative spinal disease are still an unsolvable surgical problem. It is still difficult to solve the complications related to postoperative osteoporosis, such as cage subsidence, displacement, and retraction. Expandable interbody cage is a recent innovation and an increasingly popular alternative to standard static cage. However, the clinical efficacy of MIS-TLIF combined with expandable cage for the treatment of osteoporosis has limited reports. The purpose of this paper was to analyze the efficacy of MIS-TLIF with expandable cage in patients with degenerative lumbar disease with osteoporosis. Patients with osteoporosis who received single-level MIS-TLIF and were followed up for at least 1 year were included. The outcome measures are as follows: clinical features, perioperative period, and neurological complications. JOA score and VAS pain score were used to analyze the improvement of patients’ function. Imaging analysis included segmental lordosis (SL), lumbar lordosis (LL), intervertebral disc height (DH), and the ratio of cage height to preoperative DH (RCD). The final data analysis included 284 patients with osteoporosis. 178 patients used static cages, and 106 patients used expandable cages. There was no significant difference in baseline characteristics, surgical indexes, and JOA and VAS scores between the two groups. There was no difference in SL or LL between static group and expandable group. There was no significant difference in preoperative DH between the two groups. The RCD in the expansion group was significantly lower than that in the static group. The intraoperative and postoperative sedimentation rate in the static group was significantly higher than that in the expandable group. The use of expandable cages in MIS-TLIF has shown good results for the treatment of degenerative lumbar diseases with osteoporosis. Through appropriate surgical techniques, the expandable cage can reduce the risk of cage sinking.

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“…There are many studies on the association between the low HU values and clinical effects in lumbar fusion surgery [ 17 , 30 – 32 ]. However, clinical efforts to use HU values have been relatively limited in ACCF.…”

Section: Discussionmentioning

confidence: 99%

Low cervical vertebral CT value increased early subsidence of titanium mesh cage after anterior cervical corpectomy and fusion

et al. 2022

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Study design This study was a retrospective review. Objective To study the predictive effect of Hounsfield units (HU) value in the cervical vertebral body derived from computed tomography (CT) on the early titanium mesh cage (TMC) subsidence after anterior cervical corpectomy and fusion (ACCF). Methods This retrospective study was conducted on patients who underwent ACCF at one institution between January 2014 and December 2018. We collected date included age, gender, body mass index (BMI), disease type, surgical segment, whether merge ACDF, HU value of the vertebral body and endplate, vertebral body height loss, cervical lordosis angle, and cervical sagittal alignment. VAS, JOA, and NDI were used to assess clinical efficacy. Univariate analysis was performed to screen the influencing factors of TMC subsidence, and then logistic regression was used to find out the independent risk factors. The ROC curve and area under curve (AUC) were used to analyze the HU value to predict the TMC subsidence. Results A total of 85 patients who accepted ACCF were included in this study, and early titanium mesh cage subsidence was demonstrated in 29 patients. The subsidence rate was 34.1%. The JOA, VAS, and NDI scores significantly improved in both groups after the operation. Between the subsidence and non-subsidence groups, there were significant differences in age, intervertebral distraction height, and HU value in both upper and lower vertebral body and endplate. The logistic regression analysis proved that the HU value of the lower vertebral body was an independent risk of TMC subsidence, the AUC was 0.866, and the most appropriate threshold of the HU value was 275 (sensitivity: 87.5%, specificity: 79.3%). Conclusion Preoperative cervical CT value is an independent correlative factor for early TMC subsidence after ACCF, and patients with a low CT value of the inferior vertebral body of the operative segment have a higher risk of TMC subsidence in the early postoperative period. Trial registration: This study is undergoing retrospective registration.

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Endplate volumetric bone mineral density is a predictor for cage subsidence following lateral lumbar interbody fusion: a risk factor analysis

Cited by 35 publications

References 40 publications

Influence of the geometric and material properties of lumbar endplate on lumbar interbody fusion failure: a systematic review

Influence of the geometric and material properties of lumbar endplate on lumbar interbody fusion failure: a systematic review

Comparison of Long-Term Efficacy of MIS-TLIF Intraoperative Implants in Patients with Osteoporosis

Low cervical vertebral CT value increased early subsidence of titanium mesh cage after anterior cervical corpectomy and fusion

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