Risk factors for cage migration and cage retropulsion following transforaminal lumbar interbody fusion

Park, Man Kyu; Kim, Kyoung‐Tae; Bang, Woo-Seok; Cho, Dae Chul; Sung, Joo Kyung; Lee, Young Seok; Lee, Chang Kyu; Kim, Chi Heon; Kwon, Brian K.; Lee, Won Kee; Han, Inbo

doi:10.1016/j.spinee.2018.08.007

Cited by 84 publications

(98 citation statements)

References 24 publications

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“…11 Previous reports have shown that older age, female sex, endplate injury, endplate cystic lesion (Schmorl's nodes), cage size, unilateral pedicle screw fixation, and osteoporosis may be risk factors for cage subsidence. [1][2][3][4]22 Because osteoporosis reflects low BMD, it is important to consider BMD prior to LLIF. [23][24][25] As a general rule, bone density is measured by DXA, but not all patients obtain a preoperative DXA scan.…”

Section: Discussionmentioning

confidence: 99%

“…6 Multiple studies have shown that the Hounsfield units (HUs) measured on routine lumbar spine CT scans using the picture archiving and communication system (PACS) can estimate if osteoporosis is present. 2,7,10,23,26 Because of correlation between HUs and BMD, we evaluated if preoperative HUs on CT are associated with cage subsidence after single-level LLIF for degenerative conditions of the spine.…”

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confidence: 99%

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The association between lower Hounsfield units on computed tomography and cage subsidence after lateral lumbar interbody fusion

Mummaneni²,

Wang³

et al. 2020

Neurosurgical Focus

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OBJECTIVEOne vexing problem after lateral lumbar interbody fusion (LLIF) surgery is cage subsidence. Low bone mineral density (BMD) may contribute to subsidence, and BMD is correlated with Hounsfield units (HUs) on CT. The authors investigated if lower HU values correlated with subsidence after LLIF.METHODSA retrospective study of patients undergoing single-level LLIF with pedicle screw fixation for degenerative conditions at the University of California, San Francisco, by 6 spine surgeons was performed. Data on demographics, cage parameters, preoperative HUs on CT, and postoperative subsidence were collected. Thirty-six–inch standing radiographs were used to measure segmental lordosis, disc space height, and subsidence; data were collected immediately postoperatively and at 1 year. Subsidence was graded using a published grade of disc height loss: grade 0, 0%–24%; grade I, 25%–49%; grade II, 50%–74%; and grade III, 75%–100%. HU values were measured on preoperative CT from L1 to L5, and each lumbar vertebral body HU was measured 4 separate times.RESULTSAfter identifying 138 patients who underwent LLIF, 68 met the study inclusion criteria. All patients had single-level LLIF with pedicle screw fixation. The mean follow-up duration was 25.3 ± 10.4 months. There were 40 patients who had grade 0 subsidence, 15 grade I, 9 grade II, and 4 grade III. There were no significant differences in age, sex, BMI, or smoking. There were no significant differences in cage sizes, cage lordosis, and preoperative disc height. The mean segmental HU (the average HU value of the two vertebrae above and below the LLIF) was 169.5 ± 45 for grade 0, 130.3 ± 56.2 for grade I, 100.7 ± 30.2 for grade II, and 119.9 ± 52.9 for grade III (p < 0.001). After using a receiver operating characteristic curve to establish separation criteria between mild and severe subsidence, the most appropriate threshold of HU value was 135.02 between mild and severe subsidence (sensitivity 60%, specificity 92.3%). After univariate and multivariate analysis, preoperative segmental HU value was an independent risk factor for severe cage subsidence (p = 0.017, OR 15.694, 95% CI 1.621–151.961).CONCLUSIONSLower HU values on preoperative CT are associated with cage subsidence after LLIF. Measurement of preoperative HU values on CT may be useful when planning LLIF surgery.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

The association between lower Hounsfield units on computed tomography and cage subsidence after lateral lumbar interbody fusion

Mummaneni²,

Wang³

et al. 2020

Neurosurgical Focus

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“…In the IBF group, we observed two cases with posterior cage migration and four cases with cage subsidence. Based on a previous study, osteoporosis is an important risk factor for cage migration or subsidence [24].…”

Section: Discussionmentioning

confidence: 99%

Instrumented Posterolateral fusion versus instrumented Interbody fusion for degenerative lumbar diseases in uremic patients under hemodialysis

Liao

Chen

2020

BMC Musculoskelet Disord

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Background Advances in hemodialysis have facilitated longer lifespan and better quality of life for patients with end stage renal disease (ESRD). Symptomatic degenerative lumbar diseases (DLD) becomes more common in patients with ESRD. Posterior instrumented fusion remains popular for spinal stenosis combining instability. Only a few sporadic studies mentioned about surgical outcomes in patients with ESRD underwent spine surgeries, but no one discussed about which fusion method was optimal for this kind of patients. In this study, we compared the differences between lumbar posterolateral fusion (PLF) and lumbar interbody fusion (IBF) in uremic patients underwent instrumented lumbar surgeries. Methods Between January 2005 and December 2017, ESRD patients under maintenance hemodialysis underwent posterior instrumented fusion for DLD were reviewed. A PLF group and an IBF group were identified. The demographic data was collected using their medical records. Clinical outcomes were evaluated by Oswestry Disability Index (ODI) and the visual analogue scale (VAS); radiographic results were assessed using final fusion rates. Any surgical or implant-related complication was documented. Results A total of 34 patients (22 women and 12 men, mean age of 65.4 years) in PLF group and 45 patients (26 women and 19 men, mean age of 65.1 years) in IBF group were enrolled. Both groups had similar surgical levels. The operation time was longer (200.9 vs 178.3 min, p = 0.029) and the amount of blood loss was higher (780.0 vs 428.4 ml, p = 0.001) in the IBF group. The radiographic fusion rate was better in the PLF group but without significant difference (65.2% vs 58.8%, p = 0.356). Seven in the PLF group and ten in the IBF group developed surgical complications (20.5% vs. 22.2%, p = 0.788); three patients in the PLF group (8.8%) and five patients in the IBF group (11.1%) received revision surgeries because of implant-related or wound complications. Comparing to preoperative ODI and VAS, postoperative ODI and VAS obtained significant improvement in both groups. Conclusions Successful fusion rates and clinical improvement (VAS, ODI) were similar in IBF and PLF group. Uremic patients underwent IBF for DLD had longer length of operation and higher operative blood loss than underwent PLF.

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“…To prevent cage subsidence, it should rest on the stronger anterior ring apophysis rather than just on the soft central cancellous portion. Finally, osteoporosis can result in the pedicle screws becoming loose, which subsequently would reduce axial compressive strength 15) . Therefore, it is necessary to determine the BMD of each patient prior to surgery and to provide antiosteoporosis drugs to the patients.…”

Section: ) Endplate Preparation and Fusion Ratementioning

confidence: 99%

Biportal Endoscopic Lumbar Interbody Fusion: Review of Current Evidence and the Literature

Park¹,

Son²

2021

J Minim Invasive Spine Surg Tech

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Several studies report that biportal endoscopic lumbar interbody fusion (ELIF) demonstrate various advantages such as favorable clinical outcomes, less postoperative back pain, and shorter hospital stays compared to open PLIF/MIS TLIF. Even though biportal ELIF has demonstrated several advantages, limitations are also associated with the technique, including longer operation time, limited indications, and a lack of multicenter randomized controlled trials that directly compare other fusion techniques with biportal ELIF. The objective of this review was to evaluate previously published articles and summarize current evidence on biportal ELIF regarding its indications, surgical technique, complications and comparative results with open PLIF/MIS TLIF.

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Risk factors for cage migration and cage retropulsion following transforaminal lumbar interbody fusion

Cited by 84 publications

References 24 publications

The association between lower Hounsfield units on computed tomography and cage subsidence after lateral lumbar interbody fusion

The association between lower Hounsfield units on computed tomography and cage subsidence after lateral lumbar interbody fusion

Instrumented Posterolateral fusion versus instrumented Interbody fusion for degenerative lumbar diseases in uremic patients under hemodialysis

Biportal Endoscopic Lumbar Interbody Fusion: Review of Current Evidence and the Literature

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