Vertebral body fracture after anterolateral instrumentation and interbody fusion in two osteoporotic patients

Dua, Karan; Kepler, Christopher K.; Huang, Russel C.; Marchenko, A. K.

doi:10.1016/j.spinee.2010.07.007

Cited by 55 publications

(33 citation statements)

References 18 publications

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“…Although an uncommon complication, vertebral body fractures following LLIF have been reported [33,[52][53][54][55][56][57]. Most of these fractures were associated with the use of lateral plates and vertebral screws [53,55,56].…”

Section: Vertebral Body Fracturementioning

confidence: 99%

Lateral Lumbar Interbody Fusion—Outcomes and Complications

Salzmann

Shue

Hughes

2017

Curr Rev Musculoskelet Med

115

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Purpose of Review Lateral lumbar interbody fusion (LLIF) is a relatively new, minimally invasive technique for interbody fusion. The goal of this review is to provide a general overview of LLIF with a special focus on outcomes and complications. Recent Findings Since the first description of the technique in 2006, the indications for LLIF have expanded and the rate of LLIF procedures performed in the USA has increased. LLIF has several theoretical advantages compared to other approaches including the preservation of the anterior and posterior annular/ligamentous structures, insertion of wide cages resting on the dense apophyseal ring bilaterally, and augmentation of disc height with indirect decompression of neural elements. Favorable long-term outcomes and a reduced risk of visceral/vascular injuries, incidental dural tears, and perioperative infections have been reported. However, approach-related complications such as motor and sensory deficits remain a concern. Summary In well-indicated patients, LLIF can be a safe procedure used for a variety of indications.

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Section: Vertebral Body Fracturementioning

confidence: 99%

Lateral Lumbar Interbody Fusion—Outcomes and Complications

Salzmann

Shue

Hughes

2017

Curr Rev Musculoskelet Med

115

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“…Osteoporosis may limit the applicability of these results, because a fracture may occur in the vertebral body after LLIF. 10 There have also been reports indicating that fracture may occur even without osteoporosis. 5 Furthermore, we did not perform pretesting dual-energy X-ray absorptiometry scans on the cadavers; however, this model was created to determine biomechanical stability, not to perform catastrophic or fatigue testing.…”

Section: Discussionmentioning

confidence: 99%

Biomechanical analysis of an expandable lateral cage and a static transforaminal lumbar interbody fusion cage with posterior instrumentation in an in vitro spondylolisthesis model

Mantell

Cyriac

Haines

et al. 2016

SPI

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OBJECT Insufficient biomechanical data exist from comparisons of the stability of expandable lateral cages with that of static transforaminal lumbar interbody fusion (TLIF) cages. The purpose of this biomechanical study was to compare the relative rigidity of L4–5 expandable lateral interbody constructs with or without additive pedicle screw fixation with that of L4–5 static TLIF cages in a novel cadaveric spondylolisthesis model. METHODS Eight human cadaver spines were used in this study. A spondylolisthesis model was created at the L4–5 level by creating 2 injuries. First, in each cadaver, a nucleotomy from 2 channels through the anterior side was created. Second, the cartilage of the facet joint was burred down to create a gap of 4 mm. Light-emitting-diode tracking markers were placed at L-3, L-4, L-5, and S-1. Specimens were tested in the following scenarios: intact model, bilateral pedicle screws, expandable lateral 18-mm-wide cage (alone, with unilateral pedicle screws [UPSs], and with bilateral pedicle screws [BPSs]), expandable lateral 22-mm-wide cage (alone, with UPSs, and with BPSs), and TLIF (alone, with UPSs, and with BPSs). Four of the spines were tested with the expandable lateral cages (18-mm cage followed by the 22-mm cage), and 4 of the spines were tested with the TLIF construct. All these constructs were tested in flexion-extension, axial rotation, and lateral bending. RESULTS The TLIF-alone construct was significantly less stable than the 18- and 22-mm-wide lateral lumbar interbody fusion (LLIF) constructs and the TLIF constructs with either UPSs or BPSs. The LLIF constructs alone were significantly less stable than the TLIF construct with BPSs. However, there was no significant difference between the 18-mm LLIF construct with UPSs and the TLIF construct with BPSs in any of the loading modes. CONCLUSIONS Expandable lateral cages with UPSs provide stability equivalent to that of a TLIF construct with BPSs in a degenerative spondylolisthesis model.

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“…Inadvertent endplate fracture following lateral cage placement is a fracture that can impair the biomechanical stability. 19 Although there is no congruent data regarding the clinical impact of subsidence, 7,9,16 follow-up for subsidence in LLIF. The short-term results were attributed to transient painful micromotion, in addition to pain from the fracture itself.…”

Section: Discussionmentioning

confidence: 99%

“…12 The consequences may range from a lack of clinical symptoms, to loss of disc height, loss of segmental angulation, acute low back pain, restenosis, or even a fracture of the adjacent vertebral bodies. [12][13][14][15][16] Prevention of cage subsidence is, therefore, an issue of great research interest.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2016

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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

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Vertebral body fracture after anterolateral instrumentation and interbody fusion in two osteoporotic patients

Cited by 55 publications

References 18 publications

Lateral Lumbar Interbody Fusion—Outcomes and Complications

Lateral Lumbar Interbody Fusion—Outcomes and Complications

Biomechanical analysis of an expandable lateral cage and a static transforaminal lumbar interbody fusion cage with posterior instrumentation in an in vitro spondylolisthesis model

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

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