The influence of cage positioning and cage type on cage migration and fusion rates in patients with monosegmental posterior lumbar interbody fusion and posterior fixation

Abbushi, Alexander; Čabraja, Mario; Thomale, Ulrich‐Wilhelm; Woiciechowsky, Christian; Kroppenstedt, Stefan

doi:10.1007/s00586-009-1036-3

Cited by 99 publications

(79 citation statements)

References 22 publications

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“…The initial advice for transforaminal lumbar interbody fusion (TLIF) was to place the intervertebral cage in the middle/posterior third of the disc space [25]. Posterolateral placement within the intervertebral space, where the endplate is thicker [8] and stronger [8,26], has been suggested following a biomechanical study assessing the risk of cage subsidence [14], whereas central placement has shown greater subsidence in a clinical study [15]. With regard to anterior placement, both a cadaveric [27] and a clinical study [28] involving TLIF found no difference in intervertebral lordosis when cages were placed in the anterior half of the disc space.…”

Section: Discussionmentioning

confidence: 99%

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Do position and size matter? An analysis of cage and placement variables for optimum lordosis in PLIF reconstruction

2017

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Purpose To examine monosegmental lordosis after posterior lumbar interbody fusion (PLIF) surgery and relate lordosis to cage size, shape, and placement. Methods Eighty-three consecutive patients underwent single-level PLIF with paired identical lordotic cages involving a wide decompression and bilateral facetectomies. Cage parameters relating to size (height, lordosis, and length) and placement (expressed as a ratio relative to the length of the inferior vertebral endplate) were recorded. Centre point ratio (CPR) was the distance to the centre of both cages and indicated mean position of both cages. Posterior gap ratio (PGR) was the distance to the most posterior cage and indicated position and cage length indirectly. Relationships between lordosis and cage parameters were explored. Results Mean lordosis increased by 5.98°(SD 6.86°). The cages used varied in length from 20 to 27 mm, in lordosis from 10°to 18°, and in anterior cage height from 10 to 17 mm. The mean cage placement as determined by CPR was 0.54 and by PGR was 0.16. The significant correlations were: both CPR and PGR with lordosis gain at surgery (r = 0.597 and 0.537, respectively, p \ 0.001 both), cage lordosis with the final lordosis (r = 0.234, p \ 0.05), and anterior cage height was negatively correlated with a change in lordosis (r = -0.297, p \ 0.01).Conclusion Cage size, shape, and position, in addition to surgical technique, determine lordosis during PLIF surgery. Anterior placement with sufficient ''clear space'' behind the cages is recommended. In addition, cages should be of moderate height and length, so that they act as an effective pivot for lordosis.

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Section: Discussionmentioning

confidence: 99%

“…With regard to cage shape, it has been shown that lordotic 'wedged' cages or structural allograft results in greater monosegmental lordosis than non-wedged cages [15,[32][33][34][35]. However, the effect of other cage parameters such as cage height and length has not been previously assessed.…”

Section: Discussionmentioning

confidence: 99%

Do position and size matter? An analysis of cage and placement variables for optimum lordosis in PLIF reconstruction

2017

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“…In addition, the relatively smaller contact area between the defective superior endplate of the L5 vertebra and the banana-shaped cage might influence the anterior dislodgement of the cage. Even though there have been some experimental studies that the cage shapes do not affect construct stability4,10,16), cage migration could be affected by cage type and positioning1). Therefore, a different type of cage from the banana-shaped ones could have been better for the patient in this particular case.…”

Section: Discussionmentioning

confidence: 91%

Anterior Dislodgement of a Fusion Cage after Transforaminal Lumbar Interbody Fusion for the Treatment of Isthmic Spondylolisthesis

Lee

Hong³

2013

J Korean Neurosurg Soc

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Transforaminal lumbar interbody fusion (TLIF) is commonly used procedure for spinal fusion. However, there are no reports describing anterior cage dislodgement after surgery. This report is a rare case of anterior dislodgement of fusion cage after TLIF for the treatment of isthmic spondylolisthesis with lumbosacral transitional vertebra (LSTV). A 51-year-old man underwent TLIF at L4-5 with posterior instrumentation for the treatment of grade 1 isthmic spondylolisthesis with LSTV. At 7 weeks postoperatively, imaging studies demonstrated that banana-shaped cage migrated anteriorly and anterolisthesis recurred at the index level with pseudoarthrosis. The cage was removed and exchanged by new cage through anterior approach, and screws were replaced with larger size ones and cement augmentation was added. At postoperative 2 days of revision surgery, computed tomography (CT) showed fracture on lateral pedicle and body wall of L5 vertebra. He underwent surgery again for paraspinal decompression at L4-5 and extension of instrumentation to S1 vertebra. His back and leg pains improved significantly after final revision surgery and symptom relief was maintained during follow-up period. At 6 months follow-up, CT images showed solid fusion at L4-5 level. Careful cage selection for TLIF must be done for treatment of spondylolisthesis accompanied with deformed LSTV, especially when reduction will be attempted. Banana-shaped cage should be positioned anteriorly, but anterior dislodgement of cage and reduction failure may occur in case of a highly unstable spine. Revision surgery for the treatment of an anteriorly dislodged cage may be effectively performed using an anterior approach.

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“…Clinically symptomatic cage migration into the endplates or spinal canal is a devastating cause of failed back surgery. 1 When lumbar cage subsidence occurs there are many concerns about recurrence of foraminal stenosis and sagittal malalignement. 18 Cage retropulsion leads to compression of the neural structures with progressive back pain and sciatica.…”

Section: Discussionmentioning

confidence: 99%

Posterior Revision of Lumbar Interbody Fusion Cages Migration: Clinical Case Series and Literature Review

Galhom

Elsawaf

Khattab

2017

Egyptian Spine Journal

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Background Data: Revision surgery for lumbar interbody cage migration is technically demanding.Cage related complication may lead to failure of fusion. Revision of such morbidity is associated with increased risk of permanent neurological insult. Purpose: To analyze the efficacy of posterior approach and iliac crest auto grafting technique in revision of migrated intervertebral cages. Study Design: Retrospective descriptive clinical case study. , we operated 106 patients underwent posterior lumbar interbody fusion (PLIF) with single cage application per level for treatment of degenerative spondylolisthesis. Of these, 12 patients experiencing cage subsidence and retropulsion. In subsidence, it was graded from 0 to III. Retropulsion was considered if the cage beyond the level of the posterior longitudinal line of the index two vertebrae. Patients were assessed pre-operatively for pain and clinical functional outcome by visual analogue scale (VAS) and Oswestry disability index (ODI), respectively. Patient with VAS score ≥5; at least 20% deterioration on ODI or with the superadded neurological deficit was considered candidates for revision surgery. Results: Cage migration incidence was 11.3%, with subsidence (6.7%), and retropulsion (4.6%) of all patients. The average time for subsidence was 3.3 months (range 2 to 6 months). Five patients with grade-II and III subsidence underwent revision surgery for foraminal decompression, augmenting fixation and adding postero-lateral iliac crest bone graft. Retropulsion was encountered in 4 patients and all needed revision surgery for cage retrieval and redo fusion. Grade-I subsidence could be treated conservatively. All surgically treated patients had a good result in VAS and ODI after a second surgery which maintained during follow up with P<0.05. Conclusion: Migration of posterior lumbar interbody fusion cage into the endplates or spinal canal is usually associated with patient dissatisfaction. Revision surgery indicated for cage retropulsion or high-grade subsidence. The posterior approach is technically demanding, safe, and effective for cage migration revision surgery. (2017ESJ141)

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The influence of cage positioning and cage type on cage migration and fusion rates in patients with monosegmental posterior lumbar interbody fusion and posterior fixation

Cited by 99 publications

References 22 publications

Do position and size matter? An analysis of cage and placement variables for optimum lordosis in PLIF reconstruction

Do position and size matter? An analysis of cage and placement variables for optimum lordosis in PLIF reconstruction

Anterior Dislodgement of a Fusion Cage after Transforaminal Lumbar Interbody Fusion for the Treatment of Isthmic Spondylolisthesis

Posterior Revision of Lumbar Interbody Fusion Cages Migration: Clinical Case Series and Literature Review

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