Stand-alone lumbar cage subsidence: A biomechanical sensitivity study of cage design and placement.

Calvo-Echenique, Andrea; Cegoñino, José; Chueca, Raúl; Palomar, Amaya Pérez del

doi:10.1016/j.cmpb.2018.05.022

Cited by 35 publications

(12 citation statements)

References 38 publications

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“…Furthermore, it is unclear whether the low-grade cage subsidence is true subsidence without accompanying symptoms. This needs to be investigated further when following up or during the fusion process of the cage and the vertebral bone (10,32).…”

Section: Discussionmentioning

confidence: 99%

Clinical results and complications associated with oblique lumbar interbody fusion technique

Cheng¹,

Wang²,

Zhang³

et al. 2021

Ann Transl Med

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Background: Oblique lumbar interbody fusion (OLIF) is a minimally invasive technique performed through the antero-oblique trajectory to address a wide range of lumbar pathologies. However, it can lead to complications. We reviewed the results of OLIF and discussed the effective methods to avoid such complications.Methods: Seventy-nine consecutive patients who underwent OLIF between May 2016 and July 2019 were retrospectively analyzed. They were divided into three groups: stand-alone, posterior, and lateral fixation, according to whether they were followed up with auxiliary internal fixation as well as the fixation methods.Preoperative and last follow-up visual analog scale (VAS) and Oswestry Disability Index (ODI) scores were used to assess the improvement in the lower back and leg pain as well as neurological conditions. We analyzed intervertebral disc height (DH), segmental lumbar lordotic angle (SLL), lumbar lordotic angle (LL), pelvic tilt (PT), pelvic incidence-lumbar lordosis (PI-LL) mismatch, and the cross-section area (CSA) on axial magnetic resonance imaging (MRI) image in different groups. Complications, including thigh symptoms, cage subsidence, neurological injury, and vascular injury, were also noted.Results: Seventy-nine patients were followed up postoperatively for 23.2±11.5 (range, 12-48) months.Forty-eight (61%) patients underwent stand-alone surgery (without fixation), 15 (19%) patients underwent supplemental percutaneous pedicle screw fixation (posterior fixation), and 16 (20%) patients underwent lateral vertebral instrumentation (lateral fixation). In all three groups, the VAS score and the ODI score had significantly decreased at the final follow-up compared to pre-operation. The DH, SLL, LL, CSA, PT, and PI-LL mismatch had also improved by final follow-up. The most common approach-related complication was thigh symptoms. Of the 79 patients, ipsilateral transient psoas paresis occurred in 9 (11.4%), ipsilateral transient quadriceps weakness in 2 (2.5%), and groin/thigh numbness and pain in 17 (21.5%). Cage subsidence occurred in 8 (10.1%) patients, including five cases of grade 0, one of grade I, and two of grade II. Three (3.8%) patients in this study had a vascular injury.Conclusions: OLIF is a minimally invasive and effective technique for dealing with degenerative lumbar diseases. However, it should also be noted that this approach carries risks of complications.

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Section: Discussionmentioning

confidence: 99%

Clinical results and complications associated with oblique lumbar interbody fusion technique

Cheng¹,

Wang²,

Zhang³

et al. 2021

Ann Transl Med

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“…The biomechanical study found that the larger cage had better segmental stiffness [29] . However, for individuals, we should balance the segmental stiffness and risk of nerve injury.…”

Section: Discussionmentioning

confidence: 95%

Optimal medial transforaminal lumbar interbody fusion approach with five extensive options: A simulated study on three-dimensional digital reconstructed images

Tian

et al. 2018

Journal of Orthopaedic Translation

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ObjectiveThe objective of this study is to use 3D digital lumbar models to investigate and simulate the optimal posterior operative approach for safe decompression and insertion of an interbody cage.MethodsThirty lumbar spine (L3-S1) computed tomography data are collected for 3D reconstruction. We cut medial half part of the superior facet and define the distance between the margin of the operative side of the spinous process and the medial margin of the cut superior facet as “medial distance (MD)”. Then, we cut the total superior facet and define the distance between the margin of the operative side of the spinous process and the lateral side of the junction of the pedicle and the vertebral body as “extend distance (ED)”. The feasible insertion of the current standard width size (10 mm and 12 mm) interbody cages was assessed by the two aforementioned MD and ED approaches. Besides the ED, we also simulate four other extensive options of lateral upper, lateral lower, vertical upper and lower and transmedian contralateral decompression on 3D digital lumbar model.ResultsThe MD increased from 13.48 ± 1.28 mm at L3/4 to 18.05 ± 1.43 mm at L5/S1, and the ED increased from 16.64 ± 1.34 mm at L3/4 to 21.12 ± 1.62 mm at L5/S1. To insert a 10-mm-wide cage, 16.7% (left) and 13.3% (right) of MD for L3/4 is not enough, 60.0% (left) and 46.7% (right) of MD for L3/4 is subsafe, 13.3% (left) and 16.7% (right) of MD for L4/5 is subsafe and all others are safe. To insert a 12-mm-wide cage, 76.7% (left) and 60.0% (right) of MD for L3/4 is not enough, 20.0% (left) and 30.0% (right) of MD for L3/4 is subsafe, 13.3%% (left) and 16.7% (right) of MD for L4/5 is not enough, 63.3% (left) and 56.7% (right) of MD for L4/5 is subsafe and 6.7% (left) and 10.0% (right) of MD for L5/S1 is subsafe, whereas 33.3%% (left) and 30.0% (right) of ED for L3/4 is subsafe, 3.3% (left) and 3.3% (right) of ED for L4/5 is subsafe and all others are safe. Besides the ED, on 3D models, four other extensive options could be simulated too and may need to be performed for different special individuals.ConclusionOur 3D digital image study provides a feasible optimal medial transforaminal lumbar interbody fusion approach with five extensive options on lower lumbar region. It can provide safe lumbar decompression and interbody fusion in most population. In addition, surgeons can choose the different extensive options for special individual conditions.The translational potential of this articleTransforminal lumbar interbody fusion is very common used for lumbar degenerative diseases. The optimal medial transforminal lumbar interbody fusion with five options provide a safe and precise approach for surgeons in treatment of lumbar degenerative diseases.

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“…Obviously, before bony fusion, stiff support will transfer more gravity load between vertebrae than soft disc tissue. Although the cages used in OLIF are larger than traditional cages, the stress shielding effect is still almost unavoidable in stand-alone fusion [27] . Excessive stress leads to local collapse of the endplate followed by repeated trabecular microfractures under the endplate in daily activities and causes intractable pain [28] .…”

Section: Discussionmentioning

confidence: 99%

Osteoporosis Delimit the Indication for Additional Fixation in Oblique Lumbar Interbody Fusion

Cai

Luo

Zhu

et al. 2021

Preprint

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Study design: A retrospective cohort study.Objective: To detect the boundary of indications of fixation in OLIF surgery.Methods: Review patients undergoing stand-alone or combined OLIF. Measure the disc height increment (ΔDH), foraminal height (FH), cage subsidence (CS). VAS and the ODI was used to evaluate low back pain and functionality. Multiple linear regression were used to determine the risk factors of CS.Results: A totle of 66 consecutive patients included. The BMD in combined group was significantly lower than that of stand-alone group(p=0.005). The combined group showed better FH maintenance at 6 months (p= 0.049) and last follow-up (p= 0.019). In combined group, tCS was significantly lower at all post-operation point (p≤0.001). BMD was a mild negative correlated factor for CS in combined group (r= -0.602, p= 0.001)and a strongly negative correlated factor in stand-alone group (r= -0.797, p< 0.001). Greater mCS significantly associated with worse VAS (r=0.685, p<0.001) and ODI (r=0.616, p<0.001) in stand-alone group, and this effect was significantly weakened in the combined group as VAS (r=0.427, p=0.033) and ODI (r=0.594, p=0.002). Patients with stand-alone OLIF were at risk of severe CS when BMD <-1.38, while those with combined OLIF had an equal risk when BMD < -4.77.Conclusions: The long-term fusion rates and functionality improvements of OLIF with or without fixation are comparable. Patients with BMD < -1.38 may not suitable for stand-alone procedure due to higher risk of severe CS and worse clinical outcomes. Additional fixation can extends the applicable boundary to a BMD = -4.77.

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Stand-alone lumbar cage subsidence: A biomechanical sensitivity study of cage design and placement.

Cited by 35 publications

References 38 publications

Clinical results and complications associated with oblique lumbar interbody fusion technique

Clinical results and complications associated with oblique lumbar interbody fusion technique

Optimal medial transforaminal lumbar interbody fusion approach with five extensive options: A simulated study on three-dimensional digital reconstructed images

Osteoporosis Delimit the Indication for Additional Fixation in Oblique Lumbar Interbody Fusion

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