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

Abstract

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

When to Consider Stand-Alone Lateral Lumbar Interbody Fusion: Is There a Role for a Comeback With New Implants?

“…6,15 While there are potential benefits to stand-alone LLIF that have encouraged clinicians to use this approach to manage ASD, some complications should also be consid-In another study, Marchi et al tried to identify which patients may undergo the stand-alone procedure without cage subsidence and created a score with risk factors, considering age over 61, female gender, and the presence of spondylolisthesis and scoliosis as the main determinant factors. 16 With the technological advances and the less invasive approaches, at least 2 disruptive alternatives have emerged to make the posterior-based pedicle screw fixation additional to LLIF possible, without the need to flip the patient for a different decubitus: single-position surgery in lateral and prone position. They involve inserting percutaneous pedicle screws with the patient in a lateral position or performing the LLIF in prone position.…”

“…23 Overall, patient-related factors (bone quality, age older than 60 years, smoking status, high demand levels, female gender, spondylolisthesis, and scoliosis) and technicalrelated factors (intraoperative end plate violation, smaller cages, apophyseal ring contact of the implants, material of the cage, and type of graft used) combine to determine the outcomes of stand-alone LLIF. [5][6][7][10][11][12][13][14][15][16][17][18][19][20][21][22]…”