Impaired bone mineral density as a predictor of graft subsidence following minimally invasive transpsoas lateral lumbar interbody fusion

Tempel, Zachary J.; Gandhoke, Gurpreet S.; Okonkwo, David O.; Kanter, Adam S.

doi:10.1007/s00586-015-3844-y

Cited by 125 publications

(83 citation statements)

References 34 publications

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“…Osteoporotic bone is believed to be at risk of subsidence, screw loosening and fusion failure [30–32]. In our study, the average bone mineral density change was −2.01 ± 1.28.…”

Section: Discussionmentioning

confidence: 51%

Minimally Invasive TLIF Using Unilateral Approach and Single Cage at Single Level in Patients over 65

Lee

Kim

Ryu

2016

BioMed Research International

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Background. Minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) is a widely accepted surgical procedure. But there are only a few reports of MIS-TLIF using the unilateral approach and single cage in elderly patients. Objective. The study investigated the clinical and radiological outcomes of MIS-TLIF using the unilateral approach and single cage in the patients over 65 years of age. Methods. Thirty-eight patients were followed for a mean of 15.5 ± 11.61 months. Radiological data include fusion rate, change of disc height, and central canal area. The numeric rating scale (NRS) and Oswestry disability index (ODI) were used to assess clinical outcomes. Results. The mean age of these patients at operation was 71.82 ± 4.71 years (range, 65–82 years). Evidence of fusion was observed radiologically in 64.71% at 6 months and 87.5% at 12 months after surgery, giving a final fusion rate of 100%. The mean NRS scores for back and leg pain and ODI scores improved significantly at the final follow-up. Conclusions. Clinical and radiologic outcomes of MIS-TLIF using unilateral approach and single cage in elderly patients indicate an acceptable method for the treatment of various kinds of lumbar spinal diseases.

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“…Osteoporotic bone is believed to be at risk of subsidence, screw loosening and fusion failure [30–32]. In our study, the average bone mineral density change was −2.01 ± 1.28.…”

Section: Discussionmentioning

confidence: 51%

Minimally Invasive TLIF Using Unilateral Approach and Single Cage at Single Level in Patients over 65

Lee

Kim

Ryu

2016

BioMed Research International

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“…Tempel et al in 2015 reviewed patients who underwent lateral lumbar interbody fusion to find an association between preoperative DEXA scores and interbody subsidence. 15 They found a subsidence rate of 78% in patients with low bone density ( T score less than −1.0) as compared to a subsidence rate of 22% in patients with normal bone density ( T score greater than −2.0), and this was statistically significant. Although subsidence is associated with nonunion and a return of preoperative pain, this study does not fully evaluate fusion rates.…”

Section: Resultsmentioning

confidence: 92%

“…Tempe et al, and other studies, have shown that low bone mass leads to higher rates of subsidence of interbody devices. 7,12,13,15,30 Although this is not a direct evaluation of fusion rates, it can be inferred that the lack of stability will likely lead to nonunion. The study by Schrieber et al found a correlation between low bone mass, as measure by Hounsfield units, and lower fusion rates.…”

Section: Discussionmentioning

confidence: 99%

A Systematic Review of Treatment Strategies for Degenerative Lumbar Spine Fusion Surgery in Patients With Osteoporosis

Fischer

Hanson

Eller

et al. 2016

Geriatr Orthop Surg Rehabil

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Purpose:To evaluate the current evidence in the literature on treatment strategies for degenerative lumbar spine fusion in patients with osteoporosis.Methods:A systematic review of the literature from 1950 to 2015.Results:The review of the literature yielded 15 studies on the effect of treatment options for osteoporosis on lumbar fusion rates. This study evaluated only degenerative lumbar spine conditions and excluded deformity patients. One study demonstrated an association between low bone mass as measured by Hounsfield units and lower fusion rates. Six studies evaluated perioperative medical treatment of osteoporosis and showed higher fusion rates in patients treated with alendronate and teriparatide. The strongest evidence was for perioperative teriparatide. Eight studies evaluated surgical treatment strategies in patients with osteoporosis and showed that cement augmentation of pedicle screws and expandable pedicle screws demonstrated improved fusion rates than traditional pedicle screws. The strongest evidence was for expandable pedicle screws.Conclusion:There are 15 articles evaluating osteoporosis in patients undergoing lumbar fusion and the highest level of evidence is for perioperative use of teriparatide.

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“…10,11,23 Another pathology-related criterion has been studied in LLIF subsidence: poor bone quality. Similarly to the present study, Tempel et al 18 conducted a case-control study to analyze bone mineral density (BMD) in cases that evolved with subsidence following LLIF. They found that a DEXA T score of less than -1.0 predicts subsidence, with sensitivity and specificity of 78.3 and 63.2%, respectively.…”

Section: Discussionmentioning

confidence: 99%

“…12,14,17 Based on this data, the use of 22mm or even wider cages is now recommended. Even more recent evidence has revealed that impaired bone quality 18 and inadvertent intraoperative endplate damage 19,20 can contribute to a poorer outcome. Despite the lack of research on cage settling issues, the case selection for standalone LLIFs that do not evolve to subsidence needs elucidation; the objective of this work was to identify the factors correlated with lack of cage subsidence in standalone LLIF procedures.…”

Section: Introductionmentioning

confidence: 99%

In Which Patients Is It Possible to Perform Standalone Lateral Lumbar Interbody Fusion Without Cage Subsidence?

et al. 2016

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Objective: To identify the factors related to the non-occurrence of cage subsidence in standalone lateral lumbar interbody fusion procedures. Methods: Case-control study of single level standalone lateral lumbar interbody fusion (LLIF) including 86 cases. Patients without cage subsidence composed the control group (C), while those in the subsidence group (S) developed cage subsidence. Preoperative data were examined to create a risk score based on correlation factors with S group. The proven risk factors were part of an evaluation score. Results: Of the 86 cases included, 72 were in group C and 14 in group S. The following risk factors were more prevalent in group S compared to C group: spondylolisthesis (93% vs 18%; p<0.001); scoliosis (31% vs 12%; p=0.033); women (79% vs 38%; p=0.007); older patients (average 57.0 vs 68.4 years; p=0.001). These risk factors were used in a score (0-4) to evaluate the risk in each case. The patients with higher risk scores had greater subsidence (p<0.001). Scores ≥2 were predictive of subsidence with 92% sensitivity and 72% specificity. Conclusions: It was possible to correlate the degree of subsidence in standalone LLIF procedures using demographic (age and gender) and pathological (spondylolisthesis and scoliosis) data. With a score based on risk factors and considering any score <2, the probability of non-occurrence of subsidence following standalone LLIF (negative predictive value) was 98%. (93% vs. 18%; p < 0,001); escoliose (31% vs. 12%; p = 0,033); mulheres (79% vs. 38%; p = 0,007); pacientes idosos (média de 57,0 vs. 68,4 anos; p = 0,001 (93% vs. 18%, p <0,001); escoliosis (31% vs. 12%, p = 0,033); mujeres (79% vs. 38%, p = 0,007); ancianos (media de 57,0 a 68,4 años; p = 0,001

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Impaired bone mineral density as a predictor of graft subsidence following minimally invasive transpsoas lateral lumbar interbody fusion

Cited by 125 publications

References 34 publications

Minimally Invasive TLIF Using Unilateral Approach and Single Cage at Single Level in Patients over 65

Minimally Invasive TLIF Using Unilateral Approach and Single Cage at Single Level in Patients over 65

A Systematic Review of Treatment Strategies for Degenerative Lumbar Spine Fusion Surgery in Patients With Osteoporosis

In Which Patients Is It Possible to Perform Standalone Lateral Lumbar Interbody Fusion Without Cage Subsidence?

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