Fracture of the L-4 vertebral body after use of a stand-alone interbody fusion device in degenerative spondylolisthesis for anterior L3–4 fixation

Abstract

<jats:p>Many studies attest to the excellent results achieved using anterior lumbar interbody fusion (ALIF) for degenerative spondylolisthesis. The purpose of this report is to document a rare instance of L-4 vertebral body fracture following use of a stand-alone interbody fusion device for L3–4 ALIF. The patient, a 55-year-old man, had suffered intractable pain of the back, right buttock, and left leg for several weeks. Initial radiographs showed Grade I degenerative spondylolisthesis, with instability in the sagittal plane (upon 15° rotation) and stenosis of central and both lateral recesses at the L3–4 level. Anterior lumbar interbody fusion of the affected vertebrae was subsequently conducted using a stand-alone cage/plate system. Postoperatively, the severity of spondylolisthesis diminished, with resolution of symptoms. However, the patient returned 2 months later with both leg weakness and back pain. Plain radiographs and CT indicated device failure due to anterior fracture of the L-4 vertebral body, and the spondylolisthesis had recurred. At this point, bilateral facetectomies were performed, with reduction/fixation of L3–4 by pedicle screws. Again, degenerative spondylolisthesis improved postsurgically and symptoms eased, with eventual healing of the vertebral body fracture. This report documents a rare instance of L-4 vertebral body fracture following use of a stand-alone device for ALIF at L3–4, likely as a consequence of angular instability in degenerative spondylolisthesis. Under such conditions, additional pedicle screw fixation is advised.</jats:p>

Standalone oblique lateral interbody fusion vs. combined with percutaneous pedicle screw in spondylolisthesis

“…Zeng et al [7] reported a rate of cage subsidence with standalone OLIF of 36.3%, higher than in the combined OLIF group (29.9%). Good clinical results of the OLIF without additional posterior pedicle screw fixation have been reported, but an indication was the absence of endplate damage [8][9][10][11]. Although the sample size was small in the present study, our results are supported by Zeng et al [7] and the main reason for cage subsidence is probably endplate damage during surgery.…”

“…It remains controversial as whether internal fixation is required for OLIF [7]. The standalone OLIF approach is associated with small trauma and short operation time and hospital stay [8][9][10][11]. Zeng et al [7] suggested that the rate of complications was lower with the use of combined screw fixation.…”

Complications and Prevention Strategies of Oblique Lateral Interbody Fusion Technique

“…Furthermore, OLIF has relatively broad indications, its procedure relays on small incision, it brings low risk of post-treatment trauma or bleeding and offers good stability and quick recovery. The stand-alone approach has shown the ability to reduce trauma, to greatly reduce the operation time, and to further promote the clinical application of OLIF [6][7][8][9] . Anatomy and clinical research indicates that the oblique lateral interbody fusion does not damage sacrospinalis and does not affect the endorhachis and the nerve root compared with traditional posterior lateral interbody fusion (PLIF, TLIF) [10][11][12][13][14] .…”

Evaluation of Anterior Lumbar Interbody Fusion Performed Using a Stand-Alone, Integrated Fusion Cage

“…There have been reports of vertebral body fractures related to stand-alone cages with integrated screws. [19][20][21][22] In these cases, the exact mechanism for the failures was not discerned but most were operated on for spondylolisthesis and another had bilateral spondylolysis not appreciated prior to surgery. One should carefully assess the grade of spondylolisthesis, segmental instability, and the angulation of the disc space to be treated when deciding to perform stand-alone ALIF vs ALIF with posterior fixation.…”