Subsidence Rates After Lateral Lumbar Interbody Fusion: A Systematic Review

Macki, Mohamed; Anand, Sharath Kumar; Surapaneni, Ashwin; Park, Paul; Chang, Victor

doi:10.1016/j.wneu.2018.11.121

Cited by 56 publications

(30 citation statements)

References 50 publications

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“…A larger interbody footprint has been associated with greater biomechanical stability and decreased risk of subsidence. 31,32 A systematic 2019 review of 21 publications by Macki et al 33 found subsidence in 141 of 1362 patients (10.3%) and a reoperation rate of 2.7%, which is higher than what was found in the current study.…”

Section: Discussioncontrasting

confidence: 65%

Comparative Effectiveness of Expandable Versus Static Interbody Spacers via MIS LLIF: A 2-Year Radiographic and Clinical Outcomes Study

Frisch

Huang

et al. 2019

Global Spine Journal

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Study Design: Retrospective cohort study. Objective: The purpose of this study is to compare the radiographic and clinical outcomes of expandable interbody spacers to static interbody spacers. Methods: This is a retrospective, institutional review board–exempt chart review of 62 consecutive patients diagnosed with degenerative disc disease who underwent minimally invasive spine surgery lateral lumbar interbody fusion (MIS LLIF) using static or expandable spacers. There were 27 patients treated with static spacers, and 35 with expandable spacers. Radiographic and clinical functional outcomes were collected. Statistical results were significant if P < .05. Results: Mean improvement in visual analogue scale back and leg pain scores was significantly greater in the expandable group compared to the static group at 6 and 24 months by 42.3% and 63.8%, respectively ( P < .05). Average improvement in Oswestry Disability Index scores was significantly greater in the expandable group than the static group at 3, 6, 12, and 24 months by 28%, 44%, 59%, 53%, and 89%, respectively ( P < .05). For disc height, the mean improvement from baseline to 24 months was greater in the static group compared to the expandable group ( P < .05). Implant subsidence was significantly greater in the static group (16.1%, 5/31 levels) compared with the expandable group (6.7%, 3/45 levels; P < .05). Conclusions: This study showed positive clinical and radiographic outcomes for patients who underwent MIS LLIF with expandable spacers compared to those with static spacers. Sagittal correction and pain relief was achieved and maintained through 24-month follow-up. The expandable group had a lower subsidence rate than the static group.

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Section: Discussioncontrasting

confidence: 65%

Comparative Effectiveness of Expandable Versus Static Interbody Spacers via MIS LLIF: A 2-Year Radiographic and Clinical Outcomes Study

Frisch

Huang

et al. 2019

Global Spine Journal

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“…[12][13][14] However, a critical feature that gives LLIF these advantages is the ability to maintain vertebral body separation, but these advantages can quickly disappear with subsidence. 15 In a systematic review of LLIF, Macki et al reported a 10.3% subsidence rate, 16 and previous reports have shown subsidence rates ranging from 0% to 29.7%. 11,17 However, there is controversy as to whether or not cage subsidence is even a complication, with the idea that this is an expected sequela of LLIF, and clinical and radiographic outcomes are not necessarily compromised by subsidence.…”

Section: Discussionmentioning

confidence: 98%

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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“…There was one patient (2.2%) who experience subsidence in the expandable group compared to 12 cases (32.4%) in the static group. In a systematic review by Macki et al [32], the reported incidence of subsidence with LLIF was 10.3% (n=141 out of 1,362 patients in 14 articles).…”

Section: Discussionmentioning

confidence: 99%

Comparative Effectiveness of Laterally Placed Expandable versus Static Interbody Spacers: A 1-Year Follow-Up Radiographic and Clinical Outcomes Study

Frisch

Huang

et al. 2021

Asian Spine J

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This study compared the clinical and radiographic outcomes of patients treated with expandable and static interbody spacers following minimally invasive lateral lumbar interbody fusion (MIS-LLIF) with 12-month follow-up. Overview of Literature: A common surgical option for the treatment of degenerative disk disease (DDD) is MIS-LLIF using static or expandable spacers to restore disk height (DH), neuroforaminal height (NH), and segmental lordosis. Static spacers may require excessive trialing and aggressive impaction, potentially leading to endplate disruption and subsidence. Expandable spacers allow for in situ expansion to help address complications associated with static spacers. Methods: This is an Institutional Review Board-exempt review of 69 patients (static, n=32; expandable, n=37) diagnosed with DDD who underwent MIS-LLIF at 1-2 contiguous level(s) using static or expandable spacers. Radiographic and clinical outcomes were collected and compared at pre-and postoperative time points up to 12 months. Results: The expandable group had a significantly higher mean change in Visual Analog Scale (VAS) scores at 6 weeks, 6 months, and 12 months vs. static (∆VAS at 12 months: expandable, 6.7±1.3; static, 5.1±2.6). Mean improvement of Oswestry Disability Index (ODI) scores at 3, 6, and 12 months were significantly better for the expandable group vs. static (∆ODI at 12 months: expandable, 63.2±13.2; static, 29.8±23.4). Mean DH and NH significantly increased at final follow-up for both groups, with no significant difference in DH improvement between groups. The expandable mean NH improvement at 6 weeks and 6 months was significantly greater vs. static. Segmental lordosis significantly improved in the expandable group at all time intervals vs static. Subsidence rate at 12 months was significantly lower in the expandable group (1/46, 2.2%) vs. static (12/37, 32.4%). Conclusions: Expandable spacers resulted in a significantly lower subsidence rate, improve segmental lordosis, and VAS and ODI outcomes at 12 months vs. static.

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Subsidence Rates After Lateral Lumbar Interbody Fusion: A Systematic Review

Cited by 56 publications

References 50 publications

Comparative Effectiveness of Expandable Versus Static Interbody Spacers via MIS LLIF: A 2-Year Radiographic and Clinical Outcomes Study

Comparative Effectiveness of Expandable Versus Static Interbody Spacers via MIS LLIF: A 2-Year Radiographic and Clinical Outcomes Study

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

Comparative Effectiveness of Laterally Placed Expandable versus Static Interbody Spacers: A 1-Year Follow-Up Radiographic and Clinical Outcomes Study

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