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Wu T, Wang H, Huang K, He J, Yan C, Ding C, Wang B, Liu H. Risk factors of bone loss after Prestige-LP cervical disc arthroplasty. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2024:10.1007/s00586-024-08400-9. [PMID: 39031196 DOI: 10.1007/s00586-024-08400-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Revised: 06/05/2024] [Accepted: 07/06/2024] [Indexed: 07/22/2024]
Abstract
PURPOSE Cervical disc arthroplasty (CDA) is widely employed for patients diagnosed with cervical degenerative disc disease (CDDD). Postoperative bone loss (BL) represents a radiological alteration that is a relatively novel consideration in the realm of CDA. This study endeavors to examine the risk factors associated with BL following CDA, aiming to elucidate the underlying mechanisms and the impact of BL on surgical outcomes. METHODS A retrospective study was undertaken, encompassing consecutive patients subjected to one-level CDA, two-level CDA, or two-level hybrid surgery (HS) for the treatment of CDDD at our institution. Patient demographic and perioperative data were systematically recorded. Radiological images obtained preoperatively, at 1-week post-operation, and during the last follow-up were collected and evaluated, following with statistical analyses. RESULTS A total of 295 patients and 351 arthroplasty segments were involved in this study. Univariate logistic regressions indicated that age ≥ 45 years and two-level HS was associated with lower risk of BL; and a greater ΔDA (change of disc angle before and after surgery) was correlated with an increased risk of BL. Multivariate logistic regression determined that two-level HS and greater ΔDA were independent preventative and risk factors for BL, respectively. Further analysis revealed that severe BL significantly elevated the risk of implant subsidence compared to non-BL and mild BL. CONCLUSIONS This study posited bone remodeling and micromotion as potential underlying mechanisms of BL. Subsequent research endeavors should delve into the divergent mechanisms and progression observed between lower- and higher-grade BL, aiming to prevent potential adverse outcomes associated with severe BL.
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Affiliation(s)
- Tingkui Wu
- Department of Orthopedics, West China Hospital of Sichuan University, 37 Guoxue Alley, Wuhou District, Chengdu, 610041, Sichuan Province, China
| | - Hong Wang
- Department of Orthopedics, West China Hospital of Sichuan University, 37 Guoxue Alley, Wuhou District, Chengdu, 610041, Sichuan Province, China
| | - Kangkang Huang
- Department of Orthopedics, West China Hospital of Sichuan University, 37 Guoxue Alley, Wuhou District, Chengdu, 610041, Sichuan Province, China
| | - Junbo He
- Department of Orthopedics, West China Hospital of Sichuan University, 37 Guoxue Alley, Wuhou District, Chengdu, 610041, Sichuan Province, China
| | - Chunyi Yan
- Department of Orthopedics, West China Hospital of Sichuan University, 37 Guoxue Alley, Wuhou District, Chengdu, 610041, Sichuan Province, China
| | - Chen Ding
- Department of Orthopedics, West China Hospital of Sichuan University, 37 Guoxue Alley, Wuhou District, Chengdu, 610041, Sichuan Province, China
| | - Beiyu Wang
- Department of Orthopedics, West China Hospital of Sichuan University, 37 Guoxue Alley, Wuhou District, Chengdu, 610041, Sichuan Province, China
| | - Hao Liu
- Department of Orthopedics, West China Hospital of Sichuan University, 37 Guoxue Alley, Wuhou District, Chengdu, 610041, Sichuan Province, China.
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Ye X, Li J, Shangguan Z, Wang Z, Chen G, Liu W. Are the facet joint parameters risk factors for cage subsidence after TLIF in patients with lumbar degenerative spondylolisthesis? EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2024:10.1007/s00586-024-08393-5. [PMID: 38967801 DOI: 10.1007/s00586-024-08393-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2024] [Revised: 05/31/2024] [Accepted: 06/30/2024] [Indexed: 07/06/2024]
Abstract
PURPOSE To assess whether preoperative facet joint parameters in patients with degenerative lumbar spondylolisthesis (DS) are risk factors for cage subsidence (CS) following transforaminal lumbar interbody fusion (TLIF). METHODS We enrolled 112 patients with L4-5 DS who underwent TLIF and were followed up for > 1 year. Preoperative demographic characteristics, functional areas of paraspinal muscles and psoas major muscles (PS), total functional area relative to vertebral body area, functional cross-sectional area (FCSA) of PS and lumbar spine extensor muscles, normalized FCSA of PS to the vertebral body area (FCSA/VBA), lumbar indentation value, facet joint orientation, facet joint tropism (FT), cross-sectional area of the superior articular process (SAPA), intervertebral height index, vertebral Hounsfield unit (HU) value, lordosis distribution index, t-scores, sagittal plane parameters, visual analog scale (VAS) for low back pain, VAS for leg pain, Oswestry disability index, global alignment and proportion score and European quality of life-5 dimensions (EQ-5D) were assessed. RESULTS Postoperative CS showed significant correlations with preoperative FO(L3-4), FT (L3 and L5), SAPA(L3-5), L5-HU, FCSA/VBA(L3-4), Pre- T-score, post-6-month VAS for back pain and EQ-5D scores among other factors. According to ROC curve analysis, the optimal decision points for FO(L3-4), L3-SAPA, FCSA/VBA(L3-4), L5-HU, and Pre- T-score were 35.88°, 43.76°,114.93, 1.73, 1.55, 136, and - 2.49. CONCLUSIONS This study identified preoperative FO, SAPA, preoperative CT, Pre- T-score and the FCSA/VBA as independent risk factors for CS after TLIF for DS. These risk factors should enable spinal surgeons to closely monitor and prevent the occurrence of CS.
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Affiliation(s)
- Xiaoqing Ye
- Department of Orthopedics, Fujian Medical University Union Hospital, Fuzhou, 086-350001, China
| | - Jiandong Li
- Department of Orthopedics, Fujian Medical University Union Hospital, Fuzhou, 086-350001, China
| | - Zhitao Shangguan
- Department of Orthopedics, Fujian Medical University Union Hospital, Fuzhou, 086-350001, China
| | - Zhenyu Wang
- Department of Orthopedics, Fujian Medical University Union Hospital, Fuzhou, 086-350001, China
| | - Gang Chen
- Department of Orthopedics, Fujian Medical University Union Hospital, Fuzhou, 086-350001, China.
| | - Wenge Liu
- Department of Orthopedics, Fujian Medical University Union Hospital, Fuzhou, 086-350001, China.
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Calek AK, Cornaz F, Suter M, Fasser MR, Farshad M, Widmer J. Endplate weakening during cage bed preparation significantly reduces endplate load capacity. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2024; 33:2621-2629. [PMID: 38733400 DOI: 10.1007/s00586-024-08289-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 04/17/2024] [Accepted: 04/19/2024] [Indexed: 05/13/2024]
Abstract
PURPOSE To analyze the effect of endplate weakness prior to PLIF or TLIF cage implantation and compare it to the opposite intact endplate of the same vertebral body. In addition, the influence of bone quality on endplate resistance was investigated. METHODS Twenty-two human lumbar vertebrae were tested in a ramp-to-failure test. One endplate of each vertebral body was tested intact and the other after weakening with a rasp (over an area of 200 mm2). Either a TLIF or PLIF cage was then placed and the compression load was applied across the cage until failure of the endplate. Failure was defined as the first local maximum of the force measurement. Bone quality was assessed by determining the Hounsfield units (HU) on CT images. RESULTS With an intact endplate and a TLIF cage, the median force to failure was 1276.3N (693.1-1980.6N). Endplate weakening reduced axial endplate resistance to failure by 15% (0-23%). With an intact endplate and a PLIF cage, the median force to failure was 1057.2N (701.2-1735.5N). Endplate weakening reduced axial endplate resistance to failure by 36.6% (7-47.9%). Bone quality correlated linearly with the force at which endplate failure occurred. Intact and weakened endplates showed a strong positive correlation: intact-TLIF: r = 0.964, slope of the regression line (slope) = 11.8, p < 0.001; intact-PLIF: r = 0.909, slope = 11.2, p = 5.5E-05; weakened-TLIF: r = 0.973, slope = 12.5, p < 0.001; weakened-PLIF: r = 0.836, slope = 6, p = 0.003. CONCLUSION Weakening of the endplate during cage bed preparation significantly reduces the resistance of the endplate to subsidence to failure: endplate load capacity is reduced by 15% with TLIF and 37% with PLIF. Bone quality correlates with the force at which endplate failure occurs.
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Affiliation(s)
- Anna-Katharina Calek
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland.
| | - Frédéric Cornaz
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Mauro Suter
- Spine Biomechanics, Department of Orthopedic Surgery, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Marie-Rosa Fasser
- Spine Biomechanics, Department of Orthopedic Surgery, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Mazda Farshad
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
- University Spine Center Zurich, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Jonas Widmer
- Spine Biomechanics, Department of Orthopedic Surgery, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
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Jin C, Shang J, Chen X, Zheng J, He W, He L, Han W. Can zoledronic acid reduce the risk of cage subsidence after oblique lumbar interbody fusion combined with bilateral pedicle screw fixation in the elderly population? A retrospective study. J Orthop Surg Res 2024; 19:344. [PMID: 38849941 PMCID: PMC11162006 DOI: 10.1186/s13018-024-04828-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2024] [Accepted: 05/31/2024] [Indexed: 06/09/2024] Open
Abstract
BACKGROUND The objective of this study was to evaluate the potential of zoledronic acid for reducing the incidence of cage subsidence and enhancing interbody fusion rates following oblique lumbar interbody fusion (OLIF) surgery, particularly as the first reported evidence of the role of zoledronic acid combined with OLIF. METHODS A retrospective analysis was conducted on data from 108 elderly patients treated for degenerative lumbar diseases using OLIF combined with bilateral pedicle screw fixation from January 2018 to December 2021. Patients were divided into the zoledronic acid (ZOL) group (43 patients, 67 surgical segments) and the control group (65 patients, 86 surgical segments). A comparative analysis of the radiographic and clinical outcomes between the groups was performed, employing univariate and multivariate regression analyses to explore the relationships between cage subsidence and the independent variables. RESULTS Radiographic outcomes, including anterior height, posterior height, disc height, coronal disc angle, foraminal height, and lumbar lordosis, were not significantly different between the two groups. Similarly, no statistically significant differences were noted in the back visual analog scale (VAS) scores and Oswestry Disability Index (ODI) scores between the groups. However, at the 1-year follow-up, the leg VAS score was lower in the ZOL group than in the control group (P = 0.028). The ZOL group demonstrated a notably lower cage subsidence rate (20.9%) than did the control group (43.0%) (P < 0.001). There was no significant difference in the interbody fusion rate between the ZOL group (93.0%) and the control group (90.8%). Non-use of zoledronic acid emerged as an independent risk factor for cage subsidence (OR = 6.047, P = 0.003), along with lower bone mineral density, lower postoperative anterior height, and concave endplate morphology. The model exhibited robust discriminative performance, with an area under the curve (AUC) of 0.872. CONCLUSION The administration of zoledronic acid mitigates the risk of cage subsidence following OLIF combined with bilateral pedicle screw fixation in elderly patients; however, it does not improve the interbody fusion rate.
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Affiliation(s)
- Cong Jin
- Department of Orthopedics, Shaoxing People's Hospital, Zhongxing North Road, Shaoxing, Zhejiang, 312000, China
| | - JinXiang Shang
- Department of Orthopedics, Affiliated Hospital of Shaoxing University, Shaoxing, Zhejiang, 312000, China
| | - Xi Chen
- School of Medicine, Shaoxing University, Shaoxing, Zhejiang, 312000, China
| | - Jiewen Zheng
- School of Medicine, Shaoxing University, Shaoxing, Zhejiang, 312000, China
| | - Wei He
- Department of Orthopedics, Shaoxing People's Hospital, Zhongxing North Road, Shaoxing, Zhejiang, 312000, China
| | - Lei He
- Department of Orthopedics, Shaoxing People's Hospital, Zhongxing North Road, Shaoxing, Zhejiang, 312000, China.
| | - Weiqi Han
- Department of Orthopedics, Shaoxing People's Hospital, Zhongxing North Road, Shaoxing, Zhejiang, 312000, China.
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Liu C, Zhao M, Zhang W, Wang C, Hu B, Wang K, Xu W, Li L, Si H. Biomechanical assessment of different transforaminal lumbar interbody fusion constructs in normal and osteoporotic condition: a finite element analysis. Spine J 2024; 24:1121-1131. [PMID: 38316364 DOI: 10.1016/j.spinee.2024.01.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Revised: 01/06/2024] [Accepted: 01/22/2024] [Indexed: 02/07/2024]
Abstract
BACKGROUND CONTEXT With the aging population, osteoporosis, which leads to poor fusion, has become a common challenge for lumbar surgery. In addition, most people with osteoporosis are elderly individuals with poor surgical tolerance, and poor bone quality can also weaken the stability of internal fixation. PURPOSE This study compared the fixation strength of the bilateral traditional trajectory screw structure (TT-TT), the bilateral cortical bone trajectory screw structure (CBT-CBT), and the hybrid CBT-TT (CBT screws at the cranial level and TT screws at the caudal level) structure under different bone mineral density conditions. STUDY DESIGN A finite element (FE) analysis study. METHODS Above all, we established a healthy adult lumbar spine model. Second, under normal and osteoporotic conditions, three transforaminal lumbar interbody fusion (TLIF) models were established: bilateral traditional trajectory (TT-TT) screw fixation, bilateral cortical bone trajectory (CBT-CBT) screw fixation, and hybrid cortical bone trajectory screw and traditional trajectory screw (CBT-TT) fixation. Finally, a 500-N compression load with a torque of 10 N/m was applied to simulate flexion, extension, lateral bending, and axial rotation. We compared the range of motion (ROM), adjacent disc stress, cage stress, and posterior fixation stress of the different fusion models. RESULTS Under different bone mineral density conditions, the range of motion of the fusion segment was significantly reduced. Compared to normal bone conditions, the ROM of the L4-L5 segment, the stress of the adjacent intervertebral disc, the surface stress of the cage, and the maximum stress of the posterior fixation system were all increased in osteoporosis. Under most loads, the ROM and surface stress of the cage and the maximum stress of the posterior fixation system of the TT-TT structure are the lowest under normal bone mineral density conditions. However, under osteoporotic conditions, the fixation strength of the CBT-CBT and CBT-TT structures are higher than that of the TT-TT structures under certain load conditions. At the same time, the surface stress of the intervertebral fusion cage and the maximum stress of the posterior fixation system for the two structures are lower than those of the TT-TT structure. CONCLUSION Under normal bone mineral density conditions, transforaminal lumbar interbody fusion combined with TT-TT fixation provides the best biomechanictability. However, under osteoporotic conditions, CBT-CBT and CBT-TT structures have higher fixed strength compared to TT-TT structures. The hybrid CBT-TT structure exhibits advantages in minimal trauma and fixation strength. Therefore, this seems to be an alternative fixation method for patients with osteoporosis and degenerative spinal diseases. CLINICAL SIGNIFICANCE This study provides biomechanical support for the clinical application of hybrid CBT-TT structure for osteoporotic patients undergoing TLIF surgery.
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Affiliation(s)
- Chen Liu
- Department of Orthopedics, Qilu Hospital of Shandong University, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, 250012, P.R. China
| | - Mengmeng Zhao
- School of Physics and Electronic Science, Shandong Normal University, Jinan, Shandong, 250014, P.R. China
| | - Wencan Zhang
- Department of Orthopedics, Qilu Hospital of Shandong University, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, 250012, P.R. China
| | - Chongyi Wang
- Department of Orthopedics, Qilu Hospital of Shandong University, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, 250012, P.R. China
| | - Bingtao Hu
- Department of Orthopedics, Qilu Hospital of Shandong University, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, 250012, P.R. China
| | - Kaibin Wang
- Department of Orthopedics, Qilu Hospital of Shandong University, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, 250012, P.R. China
| | - Wanlong Xu
- Department of Orthopedics, Qilu Hospital of Shandong University, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, 250012, P.R. China
| | - Le Li
- Department of Orthopedics, Qilu Hospital of Shandong University, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, 250012, P.R. China
| | - Haipeng Si
- Department of Orthopedics, Qilu Hospital of Shandong University, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, 250012, P.R. China; Department of Orthopedics, Qilu Hospital of Shandong University(Qingdao), Cheeloo College of Medicine, Shandong University, Qingdao, Shandong, 266035, P.R. China.
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Filley A, Baldwin A, Ben-Natan AR, Hansen K, Arora A, Xiao A, Hammond D, Chen C, Tweedt I, Rohde J, Link T, Berven S, Sawyer A. The influence of osteoporosis on mechanical complications in lumbar fusion surgery: a systematic review. NORTH AMERICAN SPINE SOCIETY JOURNAL 2024; 18:100327. [PMID: 38962714 PMCID: PMC11219986 DOI: 10.1016/j.xnsj.2024.100327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Revised: 04/27/2024] [Accepted: 04/30/2024] [Indexed: 07/05/2024]
Abstract
Background Adults undergoing spine surgery often have underlying osteoporosis, which may be a risk factor for postoperative complications. Although these associations have been described, osteoporosis remains profoundly underdiagnosed and undertreated in the spine surgery population. A thorough, comprehensive systematic review summarizing the relationships between bone mineral density (BMD) and specific complications of lumbar fusion surgery could be a valuable resource for raising awareness and supporting clinical practice changes. Methods PubMed, Embase, and Web of Science databases were searched for original clinical research articles reporting on BMD, or surrogate measure, as a predictor of complications in adults undergoing elective lumbar fusion for degenerative disease or deformity. Endpoints included cage subsidence, screw loosening, pseudarthrosis, vertebral fracture, junctional complications, and reoperation. Results A total of 71 studies comprising 12,278 patients were included. Overall, considerable heterogeneity in study populations, methods of bone health assessment, and definition and evaluation of clinical endpoints precluded meta-analysis. Nevertheless, low BMD was associated with higher rates of implant failures like cage subsidence and screw loosening, which were often diagnosed with concomitant pseudarthrosis. Osteoporosis was also a significant risk factor for proximal junctional kyphosis, particularly due to fracture. Many studies found surgical site-specific BMD to best predict focal complications. Functional outcomes were inconsistently addressed. Conclusions Our findings suggest osteoporosis is a significant risk factor for mechanical complications of lumbar fusion. These results emphasize the importance of preoperative osteoporosis screening, which allows for medical and surgical optimization of high-risk patients. This review also highlights current practical challenges facing bone health evaluation in patients undergoing elective surgery. Future prospective studies using standardized methods are necessary to strengthen existing evidence, identify optimal predictive thresholds, and establish specialty-specific practice guidelines. In the meantime, an awareness of the surgical implications of osteoporosis and utility of preoperative screening can provide for more informed, effective patient care.
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Affiliation(s)
- Anna Filley
- Department of Orthopaedic Surgery, University of California, 435 Warren Drive, Apt 11, San Francisco, CA, USA
| | - Avionna Baldwin
- Department of Orthopaedic Surgery, University of California, 435 Warren Drive, Apt 11, San Francisco, CA, USA
| | - Alma Rechav Ben-Natan
- Department of Neurological Surgery, University of California, San Francisco, CA, USA
| | - Keith Hansen
- Department of General Surgery, University of California, San Francisco, CA, USA
| | - Ayush Arora
- Department of Orthopaedic Surgery, University of California, 435 Warren Drive, Apt 11, San Francisco, CA, USA
| | - Angel Xiao
- Department of Orthopaedic Surgery, University of California, 435 Warren Drive, Apt 11, San Francisco, CA, USA
| | - Deana Hammond
- Department of Orthopaedic Surgery, University of California, 435 Warren Drive, Apt 11, San Francisco, CA, USA
| | - Caressa Chen
- Loyola University Medical Center; Maywood IL, USA
| | - Isobel Tweedt
- Department of Orthopaedic Surgery, University of California, 435 Warren Drive, Apt 11, San Francisco, CA, USA
- Western University of Health Sciences College of Osteopathic Medicine of the Pacific, USA
| | - James Rohde
- Department of Integrative Biology, University of California Berkeley, USA
| | - Thomas Link
- Department of Radiology and Biomedical Imagery, University of California, San Francisco, CA, USA
| | - Sigurd Berven
- Department of Orthopaedic Surgery, University of California, 435 Warren Drive, Apt 11, San Francisco, CA, USA
| | - Aenor Sawyer
- Department of Orthopaedic Surgery, University of California, 435 Warren Drive, Apt 11, San Francisco, CA, USA
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Lechtholz-Zey EA, Ayad M, Gettleman BS, Mills ES, Shelby H, Ton AT, Shah I, Wang JC, Hah RJ, Alluri RK. Systematic Review and Meta-Analysis of the Effect of Osteoporosis on Reoperation Rates and Complications after Surgical Management of Lumbar Degenerative Disease. J Bone Metab 2024; 31:114-131. [PMID: 38886969 PMCID: PMC11184153 DOI: 10.11005/jbm.2024.31.2.114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 04/21/2024] [Accepted: 04/22/2024] [Indexed: 06/20/2024] Open
Abstract
BACKGROUND There is considerable heterogeneity in findings and a lack of consensus regarding the interplay between osteoporosis and outcomes in patients with lumbar degenerative spine disease. Therefore, the purpose of this systematic review and meta-analysis was to gather and analyze existing data on the effect of osteoporosis on radiographic, surgical, and clinical outcomes following surgery for lumbar degenerative spinal disease. METHODS A systematic review was performed to determine the effect of osteoporosis on the incidence of adverse outcomes after surgical intervention for lumbar degenerative spinal diseases. The approach focused on the radiographic outcomes, reoperation rates, and other medical and surgical complications. Subsequently, a meta-analysis was performed on the eligible studies. RESULTS The results of the meta-analysis suggested that osteoporotic patients experienced increased rates of adjacent segment disease (ASD; p=0.015) and cage subsidence (p=0.001) while demonstrating lower reoperation rates than non-osteoporotic patients (7.4% vs. 13.1%; p=0.038). The systematic review also indicated that the length of stay, overall costs, rates of screw loosening, and rates of wound and other medical complications may increase in patients with a lower bone mineral density. Fusion rates, as well as patient-reported and clinical outcomes, did not differ significantly between osteoporotic and non-osteoporotic patients. CONCLUSIONS Osteoporosis was associated with an increased risk of ASD, cage migration, and possibly postoperative screw loosening, as well as longer hospital stays, incurring higher costs and an increased likelihood of postoperative complications. However, a link was not established between osteoporosis and poor clinical outcomes.
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Affiliation(s)
- Elizabeth A. Lechtholz-Zey
- Department of Orthopaedic Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA,
USA
| | - Mina Ayad
- Department of Orthopaedic Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA,
USA
| | - Brandon S. Gettleman
- Department of Orthopaedic Surgery, University of South Carolina School of Medicine, Columbia, SC,
USA
| | - Emily S. Mills
- Department of Orthopaedic Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA,
USA
| | - Hannah Shelby
- Department of Orthopaedic Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA,
USA
| | - Andy T. Ton
- Department of Orthopaedic Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA,
USA
| | - Ishan Shah
- Department of Orthopaedic Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA,
USA
| | - Jeffrey C. Wang
- Department of Orthopaedic Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA,
USA
| | - Raymond J. Hah
- Department of Orthopaedic Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA,
USA
| | - Ram K. Alluri
- Department of Orthopaedic Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA,
USA
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Calek AK, Cornaz F, Suter M, Fasser MR, Baumgartner S, Sager P, Farshad M, Widmer J. Load distribution on intervertebral cages with and without posterior instrumentation. Spine J 2024; 24:889-898. [PMID: 37924848 DOI: 10.1016/j.spinee.2023.10.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 09/18/2023] [Accepted: 10/28/2023] [Indexed: 11/06/2023]
Abstract
BACKGROUND CONTEXT Posterior and transforaminal lumbar interbody fusion (PLIF, TLIF) are well-established procedures for spinal fusion. However, little is known about load sharing between cage, dorsal construct, and biological tissue within the instrumented lumbar spine. PURPOSE The aim of this study was to quantify the forces acting on cages under axial compression force with and without posterior instrumentation. STUDY DESIGN Biomechanical cadaveric study. METHODS Ten lumbar spinal segments were tested under uniaxial compression using load cell instrumented intervertebral cages. The force was increased in 100N increments to 1000N or a force greater than 500N on one load cell. Each specimen was tested after unilateral PLIF (uPLIF), bilateral PLIF (bPLIF) and TLIF each with/without posterior instrumentation. Dorsal instrumentation was performed with 55N of compression per side. RESULTS Cage insertion resulted in median cage preloads of 16N, 29N and 35N for uPLIF, bPLIF, and TLIF. The addition of compressed dorsal instrumentation increased the median preload to 224N, 328N, and 317N, respectively. With posterior instrumentation, the percentage of the external load acting on the intervertebral cage was less than 25% at 100N (uPLIF: 14.2%; bPLIF: 16%; TLIF: 11%), less than 45% at 500N (uPLIF: 31.8%; bPLIF: 41.1%; TLIF: 37.9%) and less than 50% at 1000N (uPLIF: 40.3%; bPLIF: 49.7%; TLIF: 43.4%). Without posterior instrumentation, the percentage of external load on the cages was significantly higher with values above 50% at 100N (uPLIF: 55.6%; bPLIF: 75.5%; TLIF: 66.8%), 500N (uPLIF: 71.7%; bPLIF: 79.2%; TLIF: 65.4%), and 1000N external load (uPLIF: 73%; bPLIF: 80.5%; TLIF: 66.1%). For absolute loads, preloads and external loads must be added together. CONCLUSIONS Without posterior instrumentation, the intervertebral cages absorb more than 50% of the axial load and the load distribution is largely independent of the loading amplitude. With posterior instrumentation, the external load acting on the cages is significantly lower and the load distribution becomes load amplitude dependent, with a higher proportion of the load transferred by the cages at high loads. The bPLIF cages tend to absorb more force than the other two cage configurations. CLINICAL SIGNIFICANCE Cage instrumentation allows some of the compression force to be transmitted through the cage to the screws below, better distributing and reducing the overall force on the pedicle screws at the end of the construct and on the rods.
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Affiliation(s)
- Anna-Katharina Calek
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, Zurich CH-8008, Switzerland.
| | - Frédéric Cornaz
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, Zurich CH-8008, Switzerland
| | - Mauro Suter
- Spine Biomechanics, Department of Orthopedic Surgery, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Marie-Rosa Fasser
- Spine Biomechanics, Department of Orthopedic Surgery, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Sina Baumgartner
- Spine Biomechanics, Department of Orthopedic Surgery, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Philipp Sager
- Spine Biomechanics, Department of Orthopedic Surgery, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Mazda Farshad
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, Zurich CH-8008, Switzerland; University Spine Center Zurich, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Jonas Widmer
- Spine Biomechanics, Department of Orthopedic Surgery, Balgrist University Hospital, University of Zurich, Zurich, Switzerland.
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Tuo Y, Lin K, Yang J, Wang S, Abudouaini H. Preoperative MRI-based endplate quality: a novel tool for predicting cage subsidence after anterior cervical spine surgery. J Orthop Surg Res 2024; 19:245. [PMID: 38627743 PMCID: PMC11020445 DOI: 10.1186/s13018-024-04716-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Accepted: 04/05/2024] [Indexed: 04/19/2024] Open
Abstract
PURPOSE The objective of this study was to examine the predictive value of a newly developed MRI-based Endplate Bone Quality (EBQ) in relation to the development of cage subsidence following anterior cervical discectomy and fusion (ACDF). METHODS Patients undergoing ACDF for degenerative cervical diseases between January 2017 and June 2022 were included. Correlation between EBQ scores and segmental height loss was analyzed using Pearson's correlation. ROC analyses were employed to ascertain the EBQ cut-off values that predict the occurrence of cage subsidence. Multivariate logistic regression analyses were conducted to identify the risk factors associated with postoperative cage subsidence. RESULTS 23 individuals (14.56%) exhibited the cage subsidence after ACDF. In the nonsubsidence group, the average EBQ and lowest T-score were determined to be 4.13 ± 1.14 and - 0.84 ± 1.38 g/cm2 respectively. In contrast, the subsidence group exhibited a mean EBQ and lowest T-score of 5.38 ± 0.47 (p < 0.001) and - 1.62 ± 1.34 g/cm2 (p = 0.014), respectively. There was a significant positive correlation (r = 0.798**) between EBQ and the segmental height loss. The EBQ threshold of 4.70 yielded optimal sensitivity (73.9%) and specificity (93.3%) with AUC of 0.806. Furthermore, the lowest T-score (p = 0.045, OR 0.667) and an elevated cervical EBQ score (p < 0.001, OR 8.385) were identified as significant risk factors for cage subsidence after ACDF. CONCLUSIONS The EBQ method presents itself as a promising and efficient tool for surgeons to assess patients at risk of cage subsidence and osteoporosis prior to cervical spine surgery, utilizing readily accessible patient data.
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Affiliation(s)
- Yuan Tuo
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, No. 76, Nanguo Road, Beilin District, Xi'an, 710054, Shaanxi, China
| | - Kaiyuan Lin
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, No. 76, Nanguo Road, Beilin District, Xi'an, 710054, Shaanxi, China
| | - Junsong Yang
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, No. 76, Nanguo Road, Beilin District, Xi'an, 710054, Shaanxi, China
| | - Sibo Wang
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, No. 76, Nanguo Road, Beilin District, Xi'an, 710054, Shaanxi, China
| | - Haimiti Abudouaini
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, No. 76, Nanguo Road, Beilin District, Xi'an, 710054, Shaanxi, China.
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10
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Wang S, Liu H, Yang K, Zhang X, Hu Y, Yang H, Qu B. The Significance of Combined OSTA, HU Value and VBQ Score in Osteoporosis Screening Before Spinal Surgery. World Neurosurg 2024; 182:e692-e701. [PMID: 38081584 DOI: 10.1016/j.wneu.2023.12.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 12/04/2023] [Indexed: 01/06/2024]
Abstract
OBJECTIVE This study aimed to assess the utility of a combined assessment using the Osteoporosis Self-Assessment Tool for Asians (OSTA), Hounsfield unit (HU) value, and vertebral bone quality (VBQ) score for preoperative osteoporosis (OP) screening in patients scheduled for spinal surgery. METHODS This study encompassed 288 participants, including 128 males and 160 females. Patients were stratified into 2 groups: the OP group (T-score ≤ -2.5) and the non-OP group (T-score > -2.5), determined by dual-energy X-ray absorptiometry (DEXA). Binary logistic regression was used to construct a combined diagnostic model, and the receiver operating characteristic (ROC) curve evaluated the sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) of these metrics individually or in combination to screen for OP. RESULTS Osteoporosis patients exhibited significantly lower OSTA and HU values in comparison to non-OP patients, while their VBQ scores were significantly higher (P < 0.001). The ROC curve analysis results indicated that within the male group, the combined diagnosis had a sensitivity of 93.8%, specificity of 82.3%, accuracy of 85.2%, PPV of 63.8%, and NPV of 97.5%. In the female group, the combined diagnosis had a sensitivity of 93.9%, specificity of 87.4%, accuracy of 90.0%, PPV of 83.6%, and NPV of 95.4%. CONCLUSIONS The combined use of OSTA, HU values, and VBQ scores in preoperative OP screening for spinal surgery demonstrates significantly higher accuracy and superior screening value compared to individual assessments. These results establish a robust scientific foundation for conducting preoperative OP screening in patients undergoing spinal surgery.
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Affiliation(s)
- Song Wang
- School of clinical medicine, Chengdu Medical College, Sichuan, China
| | - Hao Liu
- Department of Orthopaedics, First Affiliated Hospital of Chengdu Medical College, Sichuan, China
| | - Kunhai Yang
- School of clinical medicine, Chengdu Medical College, Sichuan, China
| | - Xiang Zhang
- School of clinical medicine, Chengdu Medical College, Sichuan, China
| | - Yongrong Hu
- School of clinical medicine, Chengdu Medical College, Sichuan, China
| | - Hongsheng Yang
- Department of Orthopaedics, First Affiliated Hospital of Chengdu Medical College, Sichuan, China
| | - Bo Qu
- Department of Orthopaedics, First Affiliated Hospital of Chengdu Medical College, Sichuan, China.
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11
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Zavras AG, Federico V, Nolte MT, Butler AJ, Dandu N, Munim M, Harper DE, Lopez GD, DeWald CJ, An HS, Singh K, Phillips FM, Colman MW. Risk Factors for Subsidence Following Anterior Lumbar Interbody Fusion. Global Spine J 2024; 14:257-264. [PMID: 35593712 PMCID: PMC10676155 DOI: 10.1177/21925682221103588] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
STUDY DESIGN Retrospective cohort. OBJECTIVE Anterior lumbar interbody fusion (ALIF) may be complicated by subsidence, which can lead to significant morbidity including pain, disc space collapse, neural compression, segmental kyphosis, instability, and vertebral body fracture. This study sought to identify patient and procedural risk factors for subsidence in patients undergoing ALIF. METHODS This study analyzed consecutive patients who underwent ALIF at a single institution with a minimum of 2 years follow-up. Patients were grouped as either Non-Subsidence (NS-ALIF) or Cage Subsidence (CS-ALIF) based on the final postoperative radiograph. Demographic variables, operative characteristics, and radiographic outcomes were evaluated to identify significant predictors on univariate and multivariate statistics. RESULTS 144 patients (170 levels) were included with an average follow-up of 50.70 ± 28.44 months (4.23 years). The incidence of subsidence was 22.94% (39/170 levels). On univariate statistics, the CS-ALIF group was significantly older (P = .020), had higher BMI (P = .048), worse ASA (P = .001), higher prevalence of comorbid osteoporosis (P < .001), and a more anteriorly placed interbody device (P = .005). On multivariate analysis, anterior cage placement remained the only significant predictor (OR: 1.08, 95% CI: 1.03-1.14; P = .003). There was a significantly higher rate of subsequent adjacent segment surgery among the CS-ALIF group (P = .035). CONCLUSION Factors contributing to subsidence in ALIF included older age, higher BMI, severe ASA, and osteoporosis, while anterior cage placement remained the only independent predictor on multivariate analysis. Subsidence was associated with a higher rate of subsequent adjacent segment surgery. Surgical technique should optimize placement of the interbody cage and avoid overstuffing the disc space.
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Affiliation(s)
- Athan G. Zavras
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Vincent Federico
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Michael T. Nolte
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Alexander J. Butler
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Navya Dandu
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Mohammed Munim
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Daniel E. Harper
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Gregory D. Lopez
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | | | - Howard S. An
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Kern Singh
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Frank M. Phillips
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Matthew W. Colman
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
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12
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Kimura H, Fujibayashi S, Otsuki B, Shimizu T, Murata K, Takemoto M, Odate S, Shikata J, Sakamoto T, Tsutsumi R, Ota M, Kitaori T, Matsuda S. Risk Factors for Cage Migration Following Lateral Lumbar Interbody Fusion Combined With Posterior Instrumentation: A Multicenter Retrospective Study of 983 Cases. Spine (Phila Pa 1976) 2023; 48:1741-1748. [PMID: 36763826 DOI: 10.1097/brs.0000000000004602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Accepted: 01/08/2023] [Indexed: 02/12/2023]
Abstract
STUDY DESIGN A multicenter retrospective study. OBJECTIVE This study aimed to elucidate the incidence and risk factors of lateral cage migration (LCM) after lateral lumbar interbody fusion (LLIF) combined with posterior instrumentation. SUMMARY OF BACKGROUND DATA LLIF has recently become a widely accepted procedure for the treatment of lumbar degenerative diseases. Although LLIF complications include vascular, nerve, and abdominal organ injuries, few studies have identified specific risk factors for LCM after LLIF. MATERIALS AND METHODS Between January 2015 and December 2020, 983 patients with lumbar degenerative diseases or osteoporotic vertebral fractures underwent LLIF combined with posterior instrumentation. The fusion sites were located within the lumbosacral lesions. LCM was defined as a change of >3 mm in the movement of the radiopaque marker on radiographs. The patients were classified into LCM and non-LCM groups. Medical records and preoperative radiographs were also reviewed. The 1:5 nearest-neighbor propensity score matching technique was used to compare both groups, and radiologic parameters, including preoperative disk height (DH), preoperative sagittal disk angle, disk geometry, height variance (cage height minus DH), and endplate injury, were analyzed to identify the factors influencing LCM incidence. RESULTS There were 16 patients (1.6%) with LCM (10 men and 6 women; mean age 70.1 yr). The Cochran-Armitage trend test showed a linear trend toward an increased rating of LCM with an increasing number of fused segments ( P =0.003), and LCM occurred at the terminal cage-inserted disk level in all patients in the LCM group. After propensity-matched analysis, we identified high DH ( P <0.001), large sagittal disk angle ( P =0.009), round-type disk ( P =0.008), and undersized cage selection ( P <0.001) as risk factors for LCM. CONCLUSION We identified risk factors for LCM after LLIF combined with posterior instrumentation. To avoid this complication, it is important to select the appropriate cage sizes and enhance posterior fixation for at-risk patients.
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Affiliation(s)
- Hiroaki Kimura
- Department of Orthopedic Surgery, Hyogo Prefectural Amagasaki General Medical Center, Hyogo, Japan
| | - Shunsuke Fujibayashi
- Department of Orthopedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Bungo Otsuki
- Department of Orthopedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Takayoshi Shimizu
- Department of Orthopedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Koichi Murata
- Department of Orthopedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Mitsuru Takemoto
- Department of Orthopedic Surgery, Kyoto City Hospital, Kyoto, Japan
| | - Seiichi Odate
- Department of Orthopedic Surgery, Gakkentoshi Hospital, Kyoto, Japan
| | - Jitsuhiko Shikata
- Department of Orthopedic Surgery, Gakkentoshi Hospital, Kyoto, Japan
| | - Takeshi Sakamoto
- Department of Orthopedic Surgery, Osaka Red-Cross Hospital, Osaka, Japan
| | - Ryosuke Tsutsumi
- Department of Orthopedic Surgery, Osaka Red-Cross Hospital, Osaka, Japan
| | - Masato Ota
- Department of Orthopedic Surgery, Kitano Hospital, Osaka, Japan
| | | | - Shuichi Matsuda
- Department of Orthopedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Di M, Weng Y, Wang G, Bian H, Qi H, Wu H, Chen C, Dou Y, Wang Z, Ma X, Xu B, Zhu S, Lu WW, Yang Q. Cortical Endplate Bone Density Measured by Novel Phantomless Quantitative Computed Tomography May Predict Cage Subsidence more Conveniently and Accurately. Orthop Surg 2023; 15:3126-3135. [PMID: 37853959 PMCID: PMC10694013 DOI: 10.1111/os.13897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 07/19/2023] [Accepted: 07/20/2023] [Indexed: 10/20/2023] Open
Abstract
OBJECTIVE Previous studies have shown that bone mineral density (BMD) is a predictor of cage subsidence. Phantom-less quantitative computed tomography (PL-QCT) can measure volumetric bone mineral density (vBMD) of lumbar trabecular and cortical bone. The study of endplate vBMD (EP-vBMD) is important in predicting cage settlement after extreme lateral interbody fusion (XLIF). This study aimed to determine the risk factors for postoperative cage subsidence after XLIF, particularly focusing on the relationship between vBMD measured by automatic PL-QCT and cage subsidence. METHODS Patients who underwent XLIF surgery from January 2018 to October 2020 with a minimum of 6 months of follow-up were retrospectively included. Cage subsidence was defined as >2 mm cage sinking on the adjacent endplate in follow-up imaging evaluation. Outcome measures were localized vBMDs included EP-vBMDs with different region of interest (ROI) heights measured by PL-QCT based on a customized muscle-fat algorithm. Shapiro-Wilk test, one-way ANOVA, Mann-Whitney test, Fisher exact test, univariable and multivariable logistic regression and receiver operating characteristic (ROC) curve analysis were executed in this study. RESULTS One hundred and thirteen levels of 78 patients were included in the analysis. The mean age was 65 ± 7.9 years for 11 males and 67 females. Cage subsidence occurred on 45 (39.8%) surgical levels. There was no significant difference in demographics, fused levels, or preoperative radiographic parameters. 1.25-mm EP-vBMD (0.991 [0.985,0.997], p = 0.004) and P-TB-vBMD (cage-positioned trabecular volumetric bone mineral density) (0.988 [0.977-0.999], p = 0.026) were cage-subsidence relevant according to univariate analysis. Low 1.25-mm EP-vBMD (0.992 [0.985, 0.999], p = 0.029) was an independent risk factor according to multifactorial analysis. CONCLUSION Preoperative low EP-vBMD was an independent risk factor for postoperative cage subsidence after XLIF. EP-vBMD measured by most cortex-occupied ROI may be the optimal vBMD parameter for cage subsidence prediction.
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Affiliation(s)
- Mingyuan Di
- Graduate SchoolTianjin Medical UniversityTianjinChina
- Department of Spine SurgeryTianjin Hospital, Tianjin UniversityTianjinChina
| | - Yuanzhi Weng
- Department of Orthopaedics and TraumatologyLi Ka Shing Faculty of Medicine, The University of Hong KongPokfulamChina
- Department of Orthopaedics and TraumatologyThe University of Hong Kong‐Shenzhen HospitalShenzhenChina
| | - Guohua Wang
- Graduate SchoolTianjin Medical UniversityTianjinChina
- Department of Spine SurgeryTianjin Hospital, Tianjin UniversityTianjinChina
| | - Hanming Bian
- Graduate SchoolTianjin Medical UniversityTianjinChina
- Department of Spine SurgeryTianjin Hospital, Tianjin UniversityTianjinChina
| | - Huan Qi
- Department of Orthopaedics and TraumatologyLi Ka Shing Faculty of Medicine, The University of Hong KongPokfulamChina
- Department of Orthopaedics and TraumatologyThe University of Hong Kong‐Shenzhen HospitalShenzhenChina
| | - Hongjin Wu
- Graduate SchoolTianjin Medical UniversityTianjinChina
- Department of Spine SurgeryTianjin Hospital, Tianjin UniversityTianjinChina
| | - Chao Chen
- Department of Spine SurgeryTianjin Hospital, Tianjin UniversityTianjinChina
| | - Yiming Dou
- Department of Spine SurgeryTianjin Hospital, Tianjin UniversityTianjinChina
| | - Zhi Wang
- Tianjin Hospital of Tianjin UniversityTianjinChina
| | - Xinlong Ma
- Department of Spine SurgeryTianjin Hospital, Tianjin UniversityTianjinChina
| | - Baoshan Xu
- Department of Spine SurgeryTianjin Hospital, Tianjin UniversityTianjinChina
| | - Shan Zhu
- Tianjin Hospital of Tianjin UniversityTianjinChina
| | - Weijia William Lu
- Department of Orthopaedics and TraumatologyLi Ka Shing Faculty of Medicine, The University of Hong KongPokfulamChina
- Department of Orthopaedics and TraumatologyThe University of Hong Kong‐Shenzhen HospitalShenzhenChina
| | - Qiang Yang
- Department of Spine SurgeryTianjin Hospital, Tianjin UniversityTianjinChina
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14
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Weinstein MA, Ayala GA, Roura R, Christmas KN, Warren DH, Simon P. Transforaminal lumbar interbody fusion with an expandable interbody device: Two-year clinical and radiographic outcomes. NORTH AMERICAN SPINE SOCIETY JOURNAL 2023; 16:100286. [PMID: 38025939 PMCID: PMC10652136 DOI: 10.1016/j.xnsj.2023.100286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 10/10/2023] [Accepted: 10/10/2023] [Indexed: 12/01/2023]
Abstract
Background The use of interbody cages as an adjunct to lumbar spinal fusion remains an important technique to enhance segmental stability, promote solid arthrodesis, maintain neuroforaminal decompression, and preserve/improve segmental lordosis. Appropriate segmental lumbar lordosis and sagittal balance is well-known to be critical for long-term patient outcomes. This study sought to evaluate the radiographic and clinical results of TLIF in patients using an articulating, expandable cage. Primary endpoint was clinical and radiographic outcomes, including complications, at 12 and 24 months. Methods A total of 37 patients underwent open single-level or 2-level TLIF by a single surgeon using an expandable cage with concomitant bilateral pedicle screws and posterolateral arthrodesis. Clinical outcomes included ODI and VAS for back and legs. Radiographic outcomes included pelvic incidence and tilt, lumbar and segmental lordoses, and disc height at the operative level(s). All outcomes were collected at baseline, 2-weeks, 6-weeks, 3-months, 6-months, 12-months, and 24-months postop. Results A total of 28 patients were available for analysis. Nine patients failed to follow-up at 24 months. Mean ODI scores showed significant improvement, from pre-to-postoperative at 24 months (55%; p<.0001). VAS for back and legs was significantly lower at 24 months on average by 72 and 79%, respectively (p<.0001 for both). Both segmental and lumbar lordoses significantly improved by 5.3° and 4.2° (p<.0001 and p=.049), respectively. Average disc height improved by 49% or 6.1 mm (p<.001). No device-related complications nor instances of measured subsidence. One patient had a superficial infection, and another had an intraoperatively repaired incidental durotomy. Conclusions The use of an expandable cage contributed to improvement in both segmental and lumbar lordosis with no reported complications at 24-month follow-up. All clinical measures significantly improved as well. The expandable cage design represents an effective and safe option to increase cage size and allow significant segmental lordosis correction.
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Affiliation(s)
- Marc A. Weinstein
- Department of Orthopaedics and Sports Medicine of the University of South Florida Morsani School of Medicine, 13330 USF Laurel Drive, Tampa, FL, USA
- Florida Orthopaedic Institute, 13020 Telecom Prkw. N., Tampa, FL, USA
| | - Giovanni A. Ayala
- Foundation for Orthopaedic Research and Education, 4115 W Spruce St, Tampa, FL 33607, USA
| | - Raúl Roura
- Foundation for Orthopaedic Research and Education, 4115 W Spruce St, Tampa, FL 33607, USA
| | - Kaitlyn N. Christmas
- Foundation for Orthopaedic Research and Education, 4115 W Spruce St, Tampa, FL 33607, USA
| | - Deborah H. Warren
- Foundation for Orthopaedic Research and Education, 4115 W Spruce St, Tampa, FL 33607, USA
| | - Peter Simon
- Department of Orthopaedics and Sports Medicine of the University of South Florida Morsani School of Medicine, 13330 USF Laurel Drive, Tampa, FL, USA
- Foundation for Orthopaedic Research and Education, 4115 W Spruce St, Tampa, FL 33607, USA
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15
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Zhang Y, Nüesch C, Mündermann A, Halbeisen F, Schären S, Netzer C. Is Age a Risk Factor for Early Postoperative Cage Subsidence After Transforaminal Lumbar Interbody Fusion? A Retrospective Study in 170 Patients. Global Spine J 2023:21925682231217692. [PMID: 38124312 DOI: 10.1177/21925682231217692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2023] Open
Abstract
STUDY DESIGN Retrospective observational study. OBJECTIVES We aim to evaluate whether age is a risk factor for cage subsidence, and whether other patient characteristics, preoperative radiological or imaging parameters are associated with cage subsidence and the need for revision surgery in patients undergoing transforaminal lumbar interbody fusion (TLIF). METHODS Patient demographics and surgery-related information were extracted. Cage subsidence was evaluated using upright standing sagittal plane X-rays and defined as more than 2 mm migration of the cage into the adjacent vertebral body. Patients who received revision surgery within 1 year for any reason were recorded. Radiographic parameters were measured. Univariable logistic regression models were used to evaluate the risk factors for cage subsidence and need for revision surgery. RESULTS At 3-month and 1-year follow-up, cage subsidence was observed in 28 patients (16.5%) and 58 patients (34.1%), respectively. Twenty-seven patients received revision surgery within the first year after TLIF. Age (odds ratio (OR): 1.07 per year) and male sex (OR: 2.76) had a significantly increased odds ratio for cage subsidence 3 months after TLIF. Male sex (OR: 2.55) but not age was a significant risk factor for cage subsidence 1 year after TLIF. Of all assessed risk factors, only BMI (OR: 1.11 per kg/m2) had a significantly increased risk for the need of revision surgery. CONCLUSIONS Age was associated with cage subsidence 3 months but not 1 year after TLIF suggesting that age is only a risk factor for early cage subsidence and not in a longer follow-up.
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Affiliation(s)
- Yuancheng Zhang
- Department of Spine Surgery, University Hospital Basel, Basel, Switzerland
- Department of Biomedical Engineering, University of Basel, Basel, Switzerland
- Department of Clinical Research, University of Basel, Basel, Switzerland
- Department of Spine Surgery, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Corina Nüesch
- Department of Spine Surgery, University Hospital Basel, Basel, Switzerland
- Department of Biomedical Engineering, University of Basel, Basel, Switzerland
- Department of Clinical Research, University of Basel, Basel, Switzerland
- Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland
| | - Annegret Mündermann
- Department of Spine Surgery, University Hospital Basel, Basel, Switzerland
- Department of Biomedical Engineering, University of Basel, Basel, Switzerland
- Department of Clinical Research, University of Basel, Basel, Switzerland
- Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland
| | - Florian Halbeisen
- Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, Basel, Switzerland
| | - Stefan Schären
- Department of Spine Surgery, University Hospital Basel, Basel, Switzerland
- Department of Biomedical Engineering, University of Basel, Basel, Switzerland
- Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Cordula Netzer
- Department of Spine Surgery, University Hospital Basel, Basel, Switzerland
- Department of Biomedical Engineering, University of Basel, Basel, Switzerland
- Department of Clinical Research, University of Basel, Basel, Switzerland
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16
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Sultana T, Hossain M, Jeong JH, Im S. Comparative Analysis of Radiologic Outcomes Between Polyetheretherketone and Three-Dimensional-Printed Titanium Cages After Transforaminal Lumbar Interbody Fusion. World Neurosurg 2023; 179:e241-e255. [PMID: 37611804 DOI: 10.1016/j.wneu.2023.08.056] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 08/11/2023] [Accepted: 08/12/2023] [Indexed: 08/25/2023]
Abstract
OBJECTIVE Transforaminal lumbar interbody fusion (TLIF) is performed worldwide with polyetheretherketone (PEEK) and titanium (Ti) cages for the treatment of degenerative lumbar diseases. The aim of this study was to compare radiologic outcomes between a PEEK and three-dimensional-printed titanium (3DP-Ti) cage after TLIF with >1 year of follow-up. METHODS A total of 140 patients with degenerative lumbar diseases who underwent TLIF operation were included in this study. Intervertebral disc height and whole lumbar lordosis were measured and evaluated from the preoperative stage to the final follow-up. Subsidence of the cage was indicated if the cage sunk into the adjacent vertebral body or if there was a reduction in height of the fused segment by ≥3 mm during the postoperative follow-up. Migration of the cage was determined as the displacement of the interbody cage by ≥2 mm during the postoperative period. Fusion status was assessed at the 1 year and final follow-up using standard methods. RESULTS Both disc height and lumbar lordosis were well maintained throughout the study period, and no significant differences were observed between PEEK and 3DP-Ti groups. Both PEEK and 3DP-Ti cages demonstrated low rates of cage subsidence, with no significant difference was noted. A significant cage migration rate was observed in the PEEK group and the revision operation was required for 2 patients. The fusion rate of this study was not found to be statistically significant, although the 3DP-Ti cage was known to have an improved fusion rate than PEEK cage after lumbar interbody fusion. CONCLUSIONS Radiologic results suggest that the 3DP-Ti cage may be a better interbody cage for TLIF than is the PEEK cage.
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Affiliation(s)
- Tamima Sultana
- Department of Neurosurgery, College of Medicine, Soonchunhyang University, Bucheon Hospital, Bucheon, South Korea
| | - Mosharraf Hossain
- Department of Neurosurgery, College of Medicine, Soonchunhyang University, Bucheon Hospital, Bucheon, South Korea
| | - Je Hoon Jeong
- Department of Neurosurgery, College of Medicine, Soonchunhyang University, Bucheon Hospital, Bucheon, South Korea
| | - Soobin Im
- Department of Neurosurgery, College of Medicine, Soonchunhyang University, Bucheon Hospital, Bucheon, South Korea.
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Park WT, Woo IH, Park SJ, Lee GW. Predictors of Vertebral Endplate Fractures after Oblique Lumbar Interbody Fusion. Clin Orthop Surg 2023; 15:809-817. [PMID: 37811501 PMCID: PMC10551679 DOI: 10.4055/cios23037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 03/25/2023] [Accepted: 03/25/2023] [Indexed: 10/10/2023] Open
Abstract
Background Cage subsidence after oblique lumbar interbody fusion (OLIF) induces restenosis and adversely affects patient outcomes. Many studies have investigated the causes of subsidence, one of which is endplate fracture (EF). This study aimed to identify predictors of EF after OLIF. Methods This retrospective study reviewed consecutive patients who underwent OLIF at a single institute between August 2019 and February 2022. A total of 104 patients were enrolled. The patients' demographic data and surgical details were collected through chart reviews. Radiographic variables were measured. Related variables were also analyzed using binomial logistic regression, dividing each group into those with versus without EF. Results EF occurred at 30 of 164 levels (18.3%), and the binary logistic analysis revealed that sex (odds ratio [OR], 11.07), inferior endplate concave depth (OR, 1.95), disc wedge angle (OR, 1.22), lumbar lordosis (OR, 1.09), pelvic incidence (OR, 1.07), sagittal vertical axis (OR, 1.02), sacral slope (OR, 0.9), L3-4 level (OR, 0.005), and L4-5 level (OR, 0.004) were significantly related to EF. Conclusions OLIF in older Asian patients should be performed carefully after recognizing the high possibility of EF and confirming the factors that should be considered preoperatively.
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Affiliation(s)
- Wook Tae Park
- Department of Orthopedic Surgery, Yeungnam University Medical Center, Yeungnam University College of Medicine, Daegu, Korea
| | - In Ha Woo
- Department of Orthopedic Surgery, Yeungnam University Medical Center, Yeungnam University College of Medicine, Daegu, Korea
| | - Sung Jin Park
- Department of Orthopedic Surgery, Yeungnam University Medical Center, Yeungnam University College of Medicine, Daegu, Korea
| | - Gun Woo Lee
- Department of Orthopedic Surgery, Yeungnam University Medical Center, Yeungnam University College of Medicine, Daegu, Korea
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Xiao Y, Xiu P, Yang X, Wang L, Li T, Gong Q, Liu L, Song Y. Does Preoperative Modic Changes Influence the Short-term Fusion Rate of Single Level Transforaminal Lumbar Interbody Fusion?-a Matched-pair Case Control Study. Orthop Surg 2023; 15:2309-2317. [PMID: 37439298 PMCID: PMC10475667 DOI: 10.1111/os.13795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 05/12/2023] [Accepted: 05/21/2023] [Indexed: 07/14/2023] Open
Abstract
OBJECTIVE At present, the influence of Modic changes (MCs) on postoperative fusion rate of lumbar interbody fusion (LIF) is mainly focused on the medium- and long-term fusion rate, while the short-term fusion rate has not been reported. The aim of this study was to compare the short-term fusion rate of lumbar degenerative disease patients with and without MCs after single level transforaminal lumbar interbody fusion (TLIF). METHODS In this retrospective and matched-pair case control study, we included 100 patients who underwent TLIF from January 2017 to January 2020 and had at least two follow-up visits over a two-year period. Fifty patients with MCs (MCs group) were matched with 50 patients without MCs (non MCs group) for age, sex, surgical level, diagnosis, operative time, and intraoperative blood loss. We collected the X-ray and computed tomography (CT) data of patients from 3 months to 2 years after the operation to assess bony fusion and the cage union ratio. According to the type of cage, the MCs group was further divided into the nano-hydroxyapatite/polyamide 66 (n-HA/PA66) group and polyetheretherketone (PEEK) group, and the fusion performance between the two groups was compared. Finally, age, sex, body mass index (BMI), smoking and cage type were included in the logistic regression model for risk factor analysis. RESULTS The bony fusion rates in the MCs group at 3 months, 6 months, 1 year and 2 years after surgery were significantly lower than those in the non MCs group (P < 0.05) (23.8% vs 62.5%, 52.6% vs 78.9%, 61.1% vs 83.3%, 74.0% vs 90.0%). The average coronal cage union ratios of the upper and lower endplates in the MCs group were significantly lower than those in the non MCs group (54.3% ± 17.5% vs 75.0% ± 17.2%, P < 0.05; 73.3% ± 12.0% vs 84.9% ± 8.0%, P < 0.05). Similarly, analogous results were obtained by comparing the MCs and non MCs groups' three-dimensional CT sagittal plane images (62.5% ± 16.5% vs 76.1% ± 12.4%, P < 0.05; 67.0% ± 13.9% vs 79.8% ± 11.5%, P < 0.05). CONCLUSION Short-term fusion rates were lower in the MCs group than in the non MCs group. The coronal and sagittal cage union ratio in the MCs group was lower than that in the non MCs group. The fusion performance of n-HA/PA66 and PEEK cages in the MCs group was comparable.
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Affiliation(s)
- Yang Xiao
- Department of Orthopaedic, Orthopaedic Research InstituteWest China Hospital, Sichuan UniversityChengduChina
| | - Peng Xiu
- Department of Orthopaedic, Orthopaedic Research InstituteWest China Hospital, Sichuan UniversityChengduChina
| | - Xi Yang
- Department of Orthopaedic, Orthopaedic Research InstituteWest China Hospital, Sichuan UniversityChengduChina
| | - Liang Wang
- Department of Orthopaedic, Orthopaedic Research InstituteWest China Hospital, Sichuan UniversityChengduChina
| | - Tao Li
- Department of Orthopaedic, Orthopaedic Research InstituteWest China Hospital, Sichuan UniversityChengduChina
| | - Quan Gong
- Department of Orthopaedic, Orthopaedic Research InstituteWest China Hospital, Sichuan UniversityChengduChina
| | - Limin Liu
- Department of Orthopaedic, Orthopaedic Research InstituteWest China Hospital, Sichuan UniversityChengduChina
| | - Yueming Song
- Department of Orthopaedic, Orthopaedic Research InstituteWest China Hospital, Sichuan UniversityChengduChina
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Rickert M, Fennema P, Wehner D, Rahim T, Hölper B, Eichler M, Makowski M, Meurer A, Brenneis M. Postoperative cage migration and subsidence following TLIF surgery is not associated with bony fusion. Sci Rep 2023; 13:12597. [PMID: 37537231 PMCID: PMC10400549 DOI: 10.1038/s41598-023-38801-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Accepted: 07/14/2023] [Indexed: 08/05/2023] Open
Abstract
Pseudarthrosis following transforaminal interbody fusion (TLIF) is not infrequent. Although cage migration and subsidence are commonly regarded as evidence of the absence of solid fusion, there is still no evidence of the influence of cage migration and subsidence on fusion. This study aimed to evaluate cage migration and subsidence using computed tomography (CT) DICOM data following lumbar interbody fusion. The effects of cage migration and subsidence on fusion and clinical outcomes were also assessed. A postoperative CT data set of 67 patients treated with monosegmental TLIF was analyzed in terms of cage position. To assess the effects of cage migration and subsidence on fusion, 12-month postoperative CT scans were used to assess fusion status. Clinical evaluation included the visual analog scale for pain and the Oswestry Disability Index. Postoperative cage migration occurred in 85.1% of all patients, and cage subsidence was observed in 58.2%. Radiological signs of pseudarthrosis was observed in 7.5% of the patients Neither cage migration nor subsidence affected the clinical or radiographic outcomes. No correlation was found between clinical and radiographic outcomes. The incidence of cage migration was considerable. However, as cage migration and subsidence were not associated with bony fusion, their clinical significance was considered limited.
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Affiliation(s)
- Marcus Rickert
- Spine Department, Schön Klinik Lorsch, Wilhelm Leuschner Strasse 10, Lorsch, Germany.
| | - Peter Fennema
- ARM Advanced Medical Research, Hofenstrasse 89b, 8708, Männedorf, Switzerland
| | - Diana Wehner
- Wirbelsäulenzentrum Fulda/Main/Kinzig, Hailerer Straße 16, 63571, Gelnhausen, Germany
| | - Tamim Rahim
- Asklepios Klinik Wiesbaden GmbH, Geisenheimer Straße 10, 65197, Wiesbaden, Germany
| | - Bernd Hölper
- Wirbelsäulenzentrum Fulda/Main/Kinzig, Hailerer Straße 16, 63571, Gelnhausen, Germany
| | - Michael Eichler
- Wirbelsäulenzentrum Fulda/Main/Kinzig, Hailerer Straße 16, 63571, Gelnhausen, Germany
| | - Marcus Makowski
- Department of Radiology, MRI TU Munich, Klinikum rechts der isar der TU München, Ismaninger Strasse 22, Munich, Germany
| | - Andrea Meurer
- Department of Orthopedics, Orthopadische Universitatsklinik Friedrichsheim gGmbH, Frankfurt am Main, Hessen, Germany
| | - Marco Brenneis
- Department of Trauma and Orthopaedic Surgery, Goethe University Frankfurt, University Hospital, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany.
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Iwata S, Kotani T, Sakuma T, Iijima Y, Okuwaki S, Ohyama S, Maki S, Eguchi Y, Orita S, Inage K, Shiga Y, Inoue M, Akazawa T, Minami S, Ohtori S. Risk Factors for Cage Subsidence in Minimally Invasive Lateral Corpectomy for Osteoporotic Vertebral Fractures. Spine Surg Relat Res 2023; 7:356-362. [PMID: 37636151 PMCID: PMC10447195 DOI: 10.22603/ssrr.2022-0215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 12/15/2022] [Indexed: 08/29/2023] Open
Abstract
Introduction This study aims to investigate risk factors for cage subsidence following minimally invasive lateral corpectomy for osteoporotic vertebral fractures. Methods Eight males and 13 females (77.2±6.0 years old) with osteoporotic vertebral fractures who underwent single corpectomy using a wide-footprint expandable cage with at least a 1-year follow-up were retrospectively included. The endplate cage (EC) angle was defined as the angle between the vertebral body's endplate and the cage's base on the cranial and caudal sides. A sagittal computed tomography scan was performed immediately after surgery and at the final follow-up, with cage subsidence defined as subsidence of ≥2 mm on the cranial or caudal side. Risk factors were analyzed by dividing cases into groups with (n=6) and without (n=15) cage subsidence. Results No significant differences were noted in age, bone mineral density, number of fixed vertebrae, sagittal parameters, preoperative and final kyphosis angle, amount of kyphosis angle correction, bone union, screw loosening, and number of other vertebral fractures preoperatively and 1-year postoperatively between the two groups. No difference was noted in cranial EC angle, but a significant difference was noted in caudal EC angle in the group with (10.7±4.1°) and without (4.7±4.2°) subsidence (P=0.008). Logistic regression analysis with the dependent variable as presence or absence of subsidence showed that caudal EC angle (>7.5°) was a significant factor (odds ratio: 20, 95% confidence interval: 1.655-241.7, P=0.018). Conclusions In minimally invasive lateral corpectomy for osteoporotic vertebral fractures, a cage tilted more than 7.5° to the caudal vertebral endplate is a risk factor for cage subsidence. The cage should be placed as perpendicular to the endplate as possible, especially to the caudal vertebral body, to avoid cage subsidence.
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Affiliation(s)
- Shuhei Iwata
- Department of Orthopedic Surgery, Seirei Sakura Citizen Hospital, Sakura, Japan
| | - Toshiaki Kotani
- Department of Orthopedic Surgery, Seirei Sakura Citizen Hospital, Sakura, Japan
| | - Tsuyoshi Sakuma
- Department of Orthopedic Surgery, Seirei Sakura Citizen Hospital, Sakura, Japan
| | - Yasushi Iijima
- Department of Orthopedic Surgery, Seirei Sakura Citizen Hospital, Sakura, Japan
| | - Shun Okuwaki
- Department of Orthopedic Surgery, Seirei Sakura Citizen Hospital, Sakura, Japan
| | - Shuhei Ohyama
- Department of Orthopedic Surgery, Seirei Sakura Citizen Hospital, Sakura, Japan
| | - Satoshi Maki
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Yawara Eguchi
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Sumihisa Orita
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Kazuhide Inage
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Yasuhiro Shiga
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Masahiro Inoue
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Tsutomu Akazawa
- Department of Orthopedic Surgery, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Shohei Minami
- Department of Orthopedic Surgery, Seirei Sakura Citizen Hospital, Sakura, Japan
| | - Seiji Ohtori
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
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21
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Singh V, Oppermann M, Evaniew N, Soroceanu A, Nicholls F, Jacobs WB, Thomas K, Swamy G. L5-S1 Pseudoarthrosis Rate with ALIF Versus TLIF in Adult Spinal Deformity Surgeries: A Retrospective Analysis of 100 Patients. World Neurosurg 2023; 175:e1265-e1276. [PMID: 37146876 DOI: 10.1016/j.wneu.2023.04.113] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 04/24/2023] [Accepted: 04/25/2023] [Indexed: 05/07/2023]
Abstract
OBJECTIVE Lumbosacral pseudoarthrosis is a common complication following adult spine deformity (ASD) surgery. This study assessed the reoperation rate for L5-S1 pseudoarthrosis in the ASD population. Compared with transforaminal lumbar interbody fusions (TLIFs), we hypothesized that anterior lumbar interbody fusion (ALIF) would result in lower rates of L5-S1 pseudarthrosis. METHODS This is a single center study with patient data retrieved from a prospective ASD database. The patients had a long-segment fusion, ALIF or TLIF at the L5-S1 level with a 2-year follow-up and were divided into 2 groups (TLIF and ALIF). The study's primary outcome was to assess the difference in the reoperation rate for clinical pseudoarthrosis between the TLIF and the ALIF groups. The secondary outcomes measured the radiological pseudoarthrosis rate and identified risks for L5-S1 pseudoarthrosis development. RESULTS A total of 100 patients were included; 49 patients (mean age, 62.9 years; 77.5% females) were in TLIF and 51 patients (mean age, 64.4 years; 70.6% females) were in the ALIF group. Baseline characteristics were similar in both groups. Thirteen (13%) patients with L5-S1 pseudoarthrosis required reoperation. Clinical pseudoarthrosis was higher in the TLIF group than in the ALIF group (12/49 vs. 1/51; P < 0.001). Univariate analysis demonstrated a higher risk of L5-S1 pseudoarthrosis with TLIF than ALIF (risk ratio, 12.4; 95% confidence interval: 1.68-92.4; P < 0.001). Multivariate analysis revealed 4.86 times the risk of L5-S1 clinical pseudoarthrosis with TLIF than with ALIF (risk ratio, 4.86; 95% confidence interval 0.57-47; P = 0.17), but this ratio did not reach statistical significance. CONCLUSIONS No difference in reoperation risk for L5-S1 pseudarthrosis was observed based on the method of IF. rhBMP-2 was noted as a significant predictor.
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Affiliation(s)
- Vishwajeet Singh
- Division of Orthopedic Surgery Spine Program, Department of Surgery, University of Calgary, Calgary, Alberta, Canada.
| | - Marcelo Oppermann
- Division of Orthopedic Surgery Spine Program, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Nathan Evaniew
- Division of Orthopedic Surgery Spine Program, Department of Surgery, University of Calgary, Calgary, Alberta, Canada
| | - Alex Soroceanu
- Division of Orthopedic Surgery Spine Program, Department of Surgery, University of Calgary, Calgary, Alberta, Canada
| | - Fred Nicholls
- Division of Orthopedic Surgery Spine Program, Department of Surgery, University of Calgary, Calgary, Alberta, Canada
| | - W Bradley Jacobs
- Division of Neurosurgery Spine Program, Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
| | - Ken Thomas
- Division of Orthopedic Surgery Spine Program, Department of Surgery, University of Calgary, Calgary, Alberta, Canada
| | - Ganesh Swamy
- Division of Orthopedic Surgery Spine Program, Department of Surgery, University of Calgary, Calgary, Alberta, Canada
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Guo H, Song Y, Weng R, Tian H, Yuan J, Li Y. Comparison of Clinical Outcomes and Complications Between Endoscopic and Minimally Invasive Transforaminal Lumbar Interbody Fusion for Lumbar Degenerative Diseases: A Systematic Review and Meta-analysis. Global Spine J 2023; 13:1394-1404. [PMID: 36447426 PMCID: PMC10416606 DOI: 10.1177/21925682221142545] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
STUDY DESIGN Systematic review and meta-analysis. OBJECTIVE Minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) is a classic surgical procedure for the treatment of lumbar degenerative diseases (LDD). With the development of endoscopic technology, endoscopic transforaminal lumbar interbody fusion (Endo-TLIF) can also achieve adequate decompression and interbody fusion. However, whether Endo-TLIF is superior to MIS-TLIF has not been adequately studied. In this systematic review and meta-analysis, we aimed to evaluate the treatment difference between Endo-TLIF vs MIS-TLIF. METHODS We conducted a systematic review and meta-analysis of the studies to compare the clinical outcomes and complications associated with Endo-TLIF vs. MIS-TLIF for the treatment of LDD. A literature search was conducted using the PubMed, Embase, Cochrane Library and Scopus databases for studies published up to April 1, 2022. Both retrospective and prospective studies that compared between Endo-TLIF and MIS-TLIF were included. RESULTS A total of 8 studies involving 581 patients were finally included in this meta-analysis. Endo-TLIF significantly prolonged the operation time, but reduced the blood loss amount and length of hospital stay. Moreover, Endo-TLIF was superior to MIS-TLIF on relief of back pain and functional recovery in the early postoperative period. However, there were no significantly differences in long-term clinical outcomes, fusion rate and incidence of complications between Endo-TLIF and MIS-TLIF. CONCLUSIONS Endo-TLIF was similar to MIS-TLIF in the long-term clinical outcomes, fusion and complication rates. Endo-TLIF prolongs the operation time, but shortens the length of hospital stay, and has the advantages of less surgical trauma, less blood loss, faster recovery, and early postoperative back pain relief.
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Affiliation(s)
- Haiwei Guo
- The Third Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
- Guangdong Research Institute for Orthopedics & Traumatology of Chinese Medicine, Guangzhou, China
| | - Yuke Song
- The Third Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
- Guangdong Research Institute for Orthopedics & Traumatology of Chinese Medicine, Guangzhou, China
| | - Rui Weng
- The Third Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
- Guangdong Research Institute for Orthopedics & Traumatology of Chinese Medicine, Guangzhou, China
| | - Han Tian
- The Third Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Jiayao Yuan
- The Third Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Ying Li
- Department of Spine and Orthopedics, the Third Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
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23
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Han J, Han S, Meng S, Zhao X, Zhang H, Guo J, Xu D, Liu H, Chen M, Ma X, Wang Y. Application of the oblique lateral interbody fusion technique in salvage surgery: technical note and case series. Front Surg 2023; 10:1144699. [PMID: 37273825 PMCID: PMC10235443 DOI: 10.3389/fsurg.2023.1144699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Accepted: 04/03/2023] [Indexed: 06/06/2023] Open
Abstract
Objective The oblique lateral interbody fusion (OLIF) technique is a promising interbody fusion technique. This study summarizes the technical aspects of OLIF as a salvage surgery and the preliminary outcomes of a series of cases. Patients and methods A retrospective review of patients with leg or back pain induced by pseudoarthrosis or adjacent segment disease after posterior lumbar interbody fusion/transforaminal lumbar interbody fusion was done. These patients underwent salvage OLIF surgeries in our institution from January 2021 to March 2022. Variables such as the demographic, clinical, surgical, and radiological characteristics of the enrolled patients were recorded and analyzed. Results Eight patients (five females and three males; mean age 69.1 ± 5.7 years, range 63-80 years) were enrolled in this study. The mean operative time was 286.25 min (range: 230-440 min), and the estimated blood loss was 90 ml (range: 50-150 ml). Only one of the eight patients experienced a complication of lower limb motor weakness, which disappeared within 5 days after surgery. The latest data showed that the mean intervertebral space height increased from 8.36 mm preoperatively to 12.70 mm and the mean segmentary lordosis increased from 8.92° preoperatively to 15.05°. Bone fusion was achieved in all but one patient, who was followed up for only 3 months. The JOA scores Japanese Orthopaedic Association (JOA) Scores for low back pain of all patients significantly improved at the final follow-up. Conclusion OLIF provides a safe and effective salvage strategy for patients with failed posterior intervertebral fusion surgery. Patients effectively recovered intervertebral and foraminal height with no additional posterior direct decompression.
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Affiliation(s)
- Jialuo Han
- Department of Spine Surgery, The Affiliated Hospital of Qingdao University, Shandong, China
| | - Shuo Han
- Department of Spine Surgery, The Affiliated Hospital of Qingdao University, Shandong, China
| | - Shengwei Meng
- Department of Spine Surgery, The Affiliated Hospital of Qingdao University, Shandong, China
| | - Xiaodan Zhao
- Department of Radiology, The Affiliated Hospital of Qingdao University, Shandong, China
| | - Hao Zhang
- Department of Spine Surgery, The Affiliated Hospital of Qingdao University, Shandong, China
| | - Jianwei Guo
- Department of Spine Surgery, The Affiliated Hospital of Qingdao University, Shandong, China
| | - Derong Xu
- Department of Spine Surgery, The Affiliated Hospital of Qingdao University, Shandong, China
| | - Houchen Liu
- Department of Spine Surgery, The Affiliated Hospital of Qingdao University, Shandong, China
| | - Mingrui Chen
- Department of Spine Surgery, The Affiliated Hospital of Qingdao University, Shandong, China
| | - Xuexiao Ma
- Department of Spine Surgery, The Affiliated Hospital of Qingdao University, Shandong, China
| | - Yan Wang
- Department of Spine Surgery, The Affiliated Hospital of Qingdao University, Shandong, China
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24
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Hsiao PH, Lin ET, Chen HT, Lo YS. Complete Intradural Interbody Cage Migration in Lumbar Spine Surgery: A Case Report and Literature Review. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59050956. [PMID: 37241188 DOI: 10.3390/medicina59050956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 05/10/2023] [Accepted: 05/15/2023] [Indexed: 05/28/2023]
Abstract
Background: Spinal fusion is a common surgery, in which vertebrae are fused to restore spinal stability and eliminate pain during movement. The use of an interbody cage facilitates spinal fusion. However, complete cage migration into the dura matter rarely occurs and can be challenging to manage. Case Presentation: A 44-year-old man presented at our spine center with a history of incomplete paraplegia and cauda equina syndrome that had lasted for 2 years and 4 months. This condition developed after he underwent six lumbar spine surgeries to address lower back pain and right-sided sciatica. A structural allograft kidney-shaped cage was found completely within the dura at the level of the L3 vertebra. Durotomy, cage retrieval, and pedicle screw fixation from the L2 to L4 vertebrae were performed. Numbness in both lower limbs markedly decreased within several days of the operation. After four months following the progressive physical therapy, the patient could partially control both urination and defecation. Five months postoperatively, he could stand with slight assistance. Conclusions: Complete intradural cage migration is a rare and serious complication. To the best of our knowledge, this is the first reported case with such a condition in the literature. Even if treatment is delayed, surgical intervention may salvage the remaining neurologic function and may even lead to partial recovery.
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Affiliation(s)
- Pang-Hsuan Hsiao
- Department of Orthopedic Surgery, China Medical University Hospital, Taichung 404327, Taiwan
- Spine Center, China Medical University Hospital, No. 2, Xueshi Rd., North Dist., Taichung 404327, Taiwan
| | - Erh-Ti Lin
- Department of Orthopedic Surgery, China Medical University Hospital, Taichung 404327, Taiwan
| | - Hsien-Te Chen
- Department of Orthopedic Surgery, China Medical University Hospital, Taichung 404327, Taiwan
- Spine Center, China Medical University Hospital, No. 2, Xueshi Rd., North Dist., Taichung 404327, Taiwan
| | - Yuan-Shun Lo
- Department of Orthopedic Surgery, China Medical University Hospital, Taichung 404327, Taiwan
- Spine Center, China Medical University Hospital, No. 2, Xueshi Rd., North Dist., Taichung 404327, Taiwan
- Department of Orthopedic Surgery, China Medical University Beigang Hospital, Yunlin 651012, Taiwan
- Graduate Institute of Precision Engineering, National Chung Hsing University, Taichung 402204, Taiwan
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25
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Li Z, Wang X, Xie T, Pu X, Lin R, Wang L, Wang K, You X, Wu D, Huang S, Zeng J. Oblique lumbar interbody fusion combined with stress end plate augmentation and anterolateral screw fixation for degenerative lumbar spinal stenosis with osteoporosis: a matched-pair case-controlled study. Spine J 2023; 23:523-532. [PMID: 36539041 DOI: 10.1016/j.spinee.2022.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 11/18/2022] [Accepted: 12/07/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND CONTEXT Oblique lumbar interbody fusion (OLIF) has been proven to be effective in treating degenerative lumbar spinal stenosis (DLSS). Whether OLIF is suitable for treating patients with DLSS with osteoporosis (OP) is still controversial. Bone cement augmentation is widely used to enhance the internal fixation strength of osteoporotic spines. However, the effectiveness of OLIF combined with bone cement stress end plate augmentation (SEA) and anterolateral screw fixation (AF) for DLSS with OP have not confirmed yet. PURPOSE To evaluate the clinical, radiological, and functional outcomes of OLIF-AF versus OLIF-AF-SEA in the treatment of DLSS with OP. STUDY DESIGN Retrospective case-control study. PATIENT SAMPLE A total of 60 patients with OP managed for DLSS at L4-L5. OUTCOME MEASURES Visual analog scale (VAS) score of the lower back and leg, Oswestry Disability Index (ODI), disk height (DH), lumbar lordosis (LL), segmental lordosis (SL), cage subsidence and fusion rate. METHODS The study was performed as a retrospective matched-pair case‒controlled study. Patients with OP managed for DLSS at L4-L5 between October 2017 and June 2020 and completed at least 2 years of follow-up were included, which were 30 patients treated by OLIF-AF and 30 patients undergoing OLIF-AF-SEA. The demographics and radiographic data, fusion status and functional outcomes were therefore compared to evaluate the efficacy of the two approaches. RESULTS Pain and disability improved similarly in both groups at the 24-month follow-up. However, the SEA group had lower pain and functional disability at 3 months postoperatively (p<.05). The mean postoperative disc height decrease (△DH) was significantly lower in the SEA group than in the control group (1.17±0.81 mm vs 2.89±2.03 mm; p<.001). There was no significant difference in lumbar lordosis (LL) or segmental lordosis (SL) between the groups preoperatively and 1 day postoperatively. However, a statistically significant difference was observed in SL and LL between the groups at 24 months postoperatively (p<.05). CS was observed in 4 cases (13.33%) in the SEA group and 17 cases (56.67%) in the control group (p<.001). A nonsignificant difference was observed in the fusion rate between the SEA and control groups (p=.347) at 24 months postoperatively. CONCLUSIONS This study revealed that OLIF-AF-SEA was safe and effective in the treatment of DLSS with OP. Compared with OLIF-AF, OLIF-AF-SEA results in a minor postoperative disc height decrease, a lower rate of CS, better sagittal balance, and no adverse effect on interbody fusion.
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Affiliation(s)
- Zhuhai Li
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37 GuoXue Rd, Chengdu 610041, Sichuan, China; Department of Spine Surgery, The People's Hospital of Guangxi Zhuang Autonomous Region, No. 6 TaoYuan Rd, Nanning 530021, Guangxi, China
| | - Xiandi Wang
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37 GuoXue Rd, Chengdu 610041, Sichuan, China
| | - Tianhang Xie
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37 GuoXue Rd, Chengdu 610041, Sichuan, China
| | - Xingxiao Pu
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37 GuoXue Rd, Chengdu 610041, Sichuan, China
| | - Run Lin
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37 GuoXue Rd, Chengdu 610041, Sichuan, China
| | - Lihang Wang
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37 GuoXue Rd, Chengdu 610041, Sichuan, China; Department of Spine Surgery, Guizhou Provincial Orthopedics Hospital, No.206 Sixian Rd, Guiyang 550014, Guizhou, China
| | - Kai Wang
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37 GuoXue Rd, Chengdu 610041, Sichuan, China
| | - Xuanhe You
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37 GuoXue Rd, Chengdu 610041, Sichuan, China
| | - Diwei Wu
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37 GuoXue Rd, Chengdu 610041, Sichuan, China
| | - Shishu Huang
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37 GuoXue Rd, Chengdu 610041, Sichuan, China.
| | - Jiancheng Zeng
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37 GuoXue Rd, Chengdu 610041, Sichuan, China.
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Pao JL. Biportal Endoscopic Transforaminal Lumbar Interbody Fusion Using Double Cages: Surgical Techniques and Treatment Outcomes. Neurospine 2023; 20:80-91. [PMID: 37016856 PMCID: PMC10080423 DOI: 10.14245/ns.2346036.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Accepted: 03/03/2023] [Indexed: 04/03/2023] Open
Abstract
Objective: To describe the surgical techniques and the treatment outcomes of biportal endoscopic transforaminal lumbar interbody fusion (BETLIF) using double cages.Methods: This study included 89 patients with 114 fusion segments between July 2019 and May 2021. One pure polyetheretherketone (PEEK) cage and 1 composite titanium-PEEK cage were used for interbody fusion. Clinical outcomes measures included visual analogue scale (VAS) scores for lower back pain and leg pain, Oswestry Disability Index (ODI), and Japanese Orthopedic Association (JOA) scores. Computed tomography (CT) of the lumbar spine 1 year postoperatively was used to evaluate the Bridwell interbody fusion grades.Results: There were significant improvement in VAS for lower back pain from 5.2 ± 3.1 to 1.7 ± 2.1, VAS for leg pain from 6.3 ± 2.5 to 1.7 ± 2.0, ODI from 46.7 ± 17.0 to 12.7 ± 16.1, and JOA score from 15.6 ± 6.3 to 26.4 ± 3.2. The p-values were all < 0.001. The average hospital stay was 5.7 ± 1.1 days. The CT studies available for 60 fusion segments showed successful fusion (Bridwell grade I or grade II) in 56 segments (93.3%). Significant cage subsidence of more than 2 mm was only noted in 3 segments (5.0%). Complications included 1 dural tear, 2 pedicle screws malposition, and 2 epidural hematomas, in which 2 patients required reoperations.Conclusion: BETLIF with double cages provided good neural decompression and a sound environment for interbody fusion with a big cage footprint, a large amount of bone graft, endplate preservation, and segmental stability.
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Affiliation(s)
- Jwo-Luen Pao
- Department of Orthopedic Surgery, Far-Eastern Memorial Hospital, New Taipei City, Taiwan
- Longhwa University of Science and Technology, Taoyuan, Taiwan
- Corresponding Author Jwo-Luen Pao Department of Orthopedic Surgery, Far-Eastern Memorial Hospital, 21, Section 2, Nanya South Road, Banqiao District, New Taipei 22060, Taiwan
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Huang Y, Chen Q, Liu L, Feng G. Vertebral bone quality score to predict cage subsidence following oblique lumbar interbody fusion. J Orthop Surg Res 2023; 18:258. [PMID: 36991489 DOI: 10.1186/s13018-023-03729-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 03/17/2023] [Indexed: 03/31/2023] Open
Abstract
BACKGROUND Current evidence suggests that the magnetic resonance imaging (MRI)-based vertebral bone quality (VBQ) score is a good parameter for evaluating bone quality. We aimed to assess whether the VBQ score can predict the occurrence of postoperative cage subsidence after oblique lumbar interbody fusion (OLIF) surgery. METHODS Patients (n = 102) who had undergone single-level OLIF with a minimal follow-up for 1 year were reviewed in this study. Demographic and radiographic data of these patients were collected. Cage subsidence was defined as ≥ 2 mm of cage migration into the inferior endplate, superior endplate, or both. Further, the MRI-based VBQ score was measured on T1-weighted images. Moreover, univariable and multivariable binary logistic regression analyses were performed. Meanwhile, Pearson analysis was used to evaluate the correlation among the VBQ score, average lumbar dual-energy X-ray absorptiometry (DEXA) T-score, and degree of cage subsidence. Furthermore, ad-hoc analysis was used along with receiver operating characteristic curve analysis to assess the predictive ability of the VBQ score and average lumbar DEXA T-score. RESULTS Of 102 participants, cage subsidence was observed in 39 (38.24%) patients. According to the univariable analysis, patients with subsidence had older age, higher antiosteoporotic drug use, larger disk height change, a more concave morphology of inferior and superior endplates, higher VBQ score, and lower average lumbar DEXA T-score compared to patients without subsidence. In the multivariable logistic regression analysis, a higher VBQ score was significantly associated with an increased risk of subsidence (OR = 23.158 ± 0.849, 95% CI 4.381-122.399, p < 0.001), and it was the only significant and independent predictor of subsidence after OLIF. Moreover, the VBQ score was moderately correlated with the average lumbar DEXA T-score (r = - 0.576, p < 0.001) and the amount of cage subsidence (r = 0.649, p < 0.001). Furthermore, this score significantly predicted cage subsidence with an accuracy of 83.9%. CONCLUSIONS The VBQ score can independently predict postoperative cage subsidence in patients undergoing OLIF surgery.
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Affiliation(s)
- Yong Huang
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Qian Chen
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
- Department of Orthopaedics, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, China
| | - Limin Liu
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China.
| | - Ganjun Feng
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China.
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Orłowska A, Szewczenko J, Kajzer W, Goldsztajn K, Basiaga M. Study of the Effect of Anodic Oxidation on the Corrosion Properties of the Ti6Al4V Implant Produced from SLM. J Funct Biomater 2023; 14:jfb14040191. [PMID: 37103281 PMCID: PMC10145819 DOI: 10.3390/jfb14040191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 03/17/2023] [Accepted: 03/27/2023] [Indexed: 04/03/2023] Open
Abstract
Additive technologies allowed for the development of medicine and implantology, enabling the production of personalized and highly porous implants. Although implants of this type are used clinically, they are usually only heat treated. Surface modification using electrochemical methods can significantly improve the biocompatibility of biomaterials used for implants, including printed ones. The study examined the effect of anodizing oxidation on the biocompatibility of a porous implant made of Ti6Al4V by the SLM method. The study used a proprietary spinal implant intended for the treatment of discopathy in the c4–c5 section. As part of the work, the manufactured implant was assessed in terms of compliance with the requirements for implants (structure testing—metallography) and the accuracy of the pores produced (pore size and porosity). The samples were subjected to surface modification using anodic oxidation. The research was carried out for 6 weeks in in vitro conditions. Surface topographies and corrosion properties (corrosion potential, ion release) were compared for unmodified and anodically oxidized samples. The tests showed no effect of anodic oxidation on the surface topography and improved corrosion properties. Anodic oxidation stabilized the corrosion potential and limited the release of ions to the environment.
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Xie Y, Zhou Q, Wang Y, Feng C, Fan X, Yu Y. Postoperative bone graft migration into the thecal sac and shifting down to the lower level after an endoscopic lumbar interbody fusion: a case report. BMC Musculoskelet Disord 2023; 24:143. [PMID: 36823613 PMCID: PMC9948321 DOI: 10.1186/s12891-023-06247-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Accepted: 02/16/2023] [Indexed: 02/25/2023] Open
Abstract
BACKGROUND Postoperative bone graft migration (PBGM) is a fairly rare spinal postoperative complication. Its occurrence after endoscopic surgery has rarely been reported in the literature so far. This is a case report of a 52-year-old male occurring PBGM into the thecal sac in the 8th days after an endoscopic lumbar interbody fusion (ELIF), which can make surgeons more minded with such serious rare complication after BGM. CASE PRESENTATION A 52-year-old male patient, underwent a L4-5 ELIF, presented with an acute radiculopathy on right leg and urinary incontinence in the 8th postoperative day. An emergency lumbar Computed Tomography(CT scan) and Magnetic Resonance Imaging (MRI) demonstrated bone graft migration into the thecal sac at the L4-5 level, and shifting down to the lower level. The revision surgery was performed at once successfully. Finally, the patient got well managed before discharge. CONCLUSION Supported by this case report, we believe that PBGM into the thecal sac is a rare but horrible complication of ELIF. However, too much volume of bone graft and its posterior placement are more prone to developing this complication. Finally, we are not sure that the outcome presented in this study will be repeated in future cases.
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Affiliation(s)
- Yizhou Xie
- grid.415440.0Hospital of Chengdu University of Traditional Chinese Medicine, Sichuan Procince, No.39 Shi-Er-Qiao Road, Chengdu, 610072 People’s Republic of China
| | - Qun Zhou
- grid.411304.30000 0001 0376 205XChengdu University of Traditional Chinese Medicine, Sichuan Province, No.1166 Liu-Tai Avenue, Chengdu, 611137 People’s Republic of China
| | - Yongtao Wang
- grid.415440.0Hospital of Chengdu University of Traditional Chinese Medicine, Sichuan Procince, No.39 Shi-Er-Qiao Road, Chengdu, 610072 People’s Republic of China
| | - Chengzhi Feng
- grid.415440.0Hospital of Chengdu University of Traditional Chinese Medicine, Sichuan Procince, No.39 Shi-Er-Qiao Road, Chengdu, 610072 People’s Republic of China
| | - Xiaohong Fan
- grid.415440.0Hospital of Chengdu University of Traditional Chinese Medicine, Sichuan Procince, No.39 Shi-Er-Qiao Road, Chengdu, 610072 People’s Republic of China
| | - Yang Yu
- Hospital of Chengdu University of Traditional Chinese Medicine, Sichuan Procince, No.39 Shi-Er-Qiao Road, Chengdu, 610072, People's Republic of China.
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Toop N, Dhaliwal J, Grossbach A, Gibbs D, Reddy N, Keister A, Mallory N, Xu D, Viljoen S. Subsidence Rates Associated With Porous 3D-Printed Versus Solid Titanium Cages in Transforaminal Lumbar Interbody Fusion. Global Spine J 2023:21925682231157762. [PMID: 36786680 DOI: 10.1177/21925682231157762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/15/2023] Open
Abstract
STUDY DESIGN Retrospective Cohort Study. OBJECTIVE To determine whether 3D-printed porous titanium (3DPT) interbody cages offer any clinical or radiographic advantage over standard solid titanium (ST) interbody cages in transforaminal lumbar interbody fusions (TLIF). METHODS A consecutive series of adult patients undergoing one- or two-level TLIF with either 3DPT or ST "banana" cages were analyzed for patient reported outcome measures (PROMs), radiographic complications, and clinical complications. Exclusion criteria included clinical or radiographic follow-up less than 1 year. RESULTS The final cohort included 90 ST interbody levels from 74 patients, and 73 3DPT interbody levels from 50 patients for a total of 124 patients. Baseline demographic variables and comorbidity rates were similar between groups (P > .05). Subsidence of any grade occurred more frequently in the ST group compared with the 3DPT group (24.4% vs 5.5%, respectively, P = .001). Further, the ST group was more likely to have higher grades of subsidence than the 3DPT group (P = .009). All PROMs improved similarly after surgery and revision rates did not differ between groups (both P > .05). On multivariate analysis, significant positive correlators with increasing subsidence grade included greater age (P = .015), greater body mass index (P = .043), osteoporosis/osteopenia (P < .027), and ST cage type (P = .019). CONCLUSIONS When considering interbody material for TLIF, both ST and 3DPT cages performed well; however, 3DPT cages were associated with lower rates of subsidence. The clinical relevance of these findings deserves further randomized, prospective investigation.
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Affiliation(s)
- Nathaniel Toop
- Department of Neurosurgery, Ohio State University School of Medicine, Columbus, OH, USA
| | - Joravar Dhaliwal
- Department of Neurosurgery, Ohio State University School of Medicine, Columbus, OH, USA
| | - Andrew Grossbach
- Department of Neurosurgery, Ohio State University School of Medicine, Columbus, OH, USA
| | - David Gibbs
- Ohio State University School of Medicine, Columbus, OH, USA
| | - Nihaal Reddy
- Ohio State University School of Medicine, Columbus, OH, USA
| | | | - Noah Mallory
- Ohio State University School of Medicine, Columbus, OH, USA
| | - David Xu
- Department of Neurosurgery, Ohio State University School of Medicine, Columbus, OH, USA
| | - Stephanus Viljoen
- Department of Neurosurgery, Ohio State University School of Medicine, Columbus, OH, USA
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Hou Y, Shi H, Shi H, Zhao T, Shi J, Shi G. A meta-analysis of risk factors for cage migration after lumbar fusion surgery. World Neurosurg X 2023; 18:100152. [PMID: 36785623 PMCID: PMC9918778 DOI: 10.1016/j.wnsx.2023.100152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 01/10/2023] [Indexed: 01/20/2023] Open
Abstract
Objective Cage migration is a rare complication after lumbar fusion surgery, and it is also the cause of lumbar revision surgery. Previous studies have reported that many influencing factors can increase the incidence of cage migration. However, there still remains controversial. The current study was conducted to investigate the risk factors influencing incidence of cage migration. Methods A systematic database search of PubMed, Embase, Web of Science, Cochrane Library and Clinical Trials was performed for relevant articles published until July 2022. According to the inclusion and exclusion criteria, two evaluators independently conducted literature screening, data extraction and quality evaluation of the obtained literature. The Newcastle-Ottawa Scale (NOS) score was used for quality evaluation, and meta-analysis was performed by STATA 16.0 software. Results A total of 2126 relevant articles were initially identified, and 7 articles were finally included in this study for data extraction and meta-analysis. The results of meta-analysis showed that the bony endplate injury, pear-shaped disc, and screw loosening are significantly correlated with cage migration. The OR values (95%CI) of the three factors were 7.170 (3.015, 17.051), 8.056 (4.050, 16.023), and 12.840 (3.570, 46.177) respectively. Conclusion Bony endplate injury, pear-shaped disc, and screw loosening are the current risk factors for cage migration postoperatively.
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Peng JC, Guo HZ, Zhan CG, Huang HS, Ma YH, Zhang SC, Xu YR, Mo GY, Tang YC. Comparison of pedicle screw fixation with or without cement augmentation for treating single-segment isthmic spondylolisthesis in the osteoporotic spine. Sci Rep 2023; 13:827. [PMID: 36646752 PMCID: PMC9842729 DOI: 10.1038/s41598-023-27539-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 01/04/2023] [Indexed: 01/18/2023] Open
Abstract
The present study examined the necessity of cement-augmented pedicle screw fixation in osteoporotic patients with single-segment isthmic spondylolisthesis.Fifty-nine cases were reviewed retrospectively. Thirty-three cases were in the polymethylmethacrylate-augmented pedicle screw (PMMA-PS) group, and the other 26 cases were in the conventional pedicle screw (CPS) group. Evaluation data included operation time, intraoperative blood loss, hospitalization cost, hospitalization days, rates of fusion, screw loosening, bone cement leakage, visual analogue scale (VAS) scores, Oswestry disability index (ODI), lumbar lordosis (LL), pelvic tilt (PT) and sacral slope (SS).The operation time and blood loss in the CPS group decreased significantly compared to those in the PMMA-PS group. The average hospitalization cost of the PMMA-PS group was significantly higher than that of the CPS group. There was no significant difference in the average hospital stay between the 2 groups. The initial and last follow-up postoperative VAS and ODI scores improved significantly in the two groups. There were no significant differences in VAS and ODI between the 2 groups at each time point. The last postoperative spine-pelvic parameters were significantly improved compared with those preoperatively. In the PMMA-PS group, the fusion rate was 100%. The fusion rate was 96.15% in the CPS group. No significant difference was found between the two groups for the fusion rate. Nine patients in the PMMA-PS group had bone cement leakage. There was no screw loosening in the PMMA-PS group. There were 2 cases of screw loosening in the CPS group. There were no significant differences in screw loosening, postoperative adjacent segment fractures, postoperative infection or postoperative revision between the 2 groups. The use of PMMA-PS on a regular basis is not recommended in posterior lumbar interbody fusion for the treatment of single-segment isthmic spondylolisthesis with osteoporosis.
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Affiliation(s)
- Jian-Cheng Peng
- Longgang Orthopedics Hospital of Shenzhen, Shenzhen, 518100, China
| | - Hui-Zhi Guo
- The 1St Institute of Clinical Medicine, Guangzhou University of Chinese Medicine, 12 Airport Road, Baiyun District, Guangzhou, 510405, Guangdong, China.,Spine Surgery Department, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510407, China
| | - Chen-Guang Zhan
- The 1St Institute of Clinical Medicine, Guangzhou University of Chinese Medicine, 12 Airport Road, Baiyun District, Guangzhou, 510405, Guangdong, China.,Spine Surgery Department, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510407, China
| | - Hua-Sheng Huang
- The 1St Institute of Clinical Medicine, Guangzhou University of Chinese Medicine, 12 Airport Road, Baiyun District, Guangzhou, 510405, Guangdong, China.,Spine Surgery Department, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510407, China
| | - Yan-Huai Ma
- The 1St Institute of Clinical Medicine, Guangzhou University of Chinese Medicine, 12 Airport Road, Baiyun District, Guangzhou, 510405, Guangdong, China.,Spine Surgery Department, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510407, China
| | - Shun-Cong Zhang
- The 1St Institute of Clinical Medicine, Guangzhou University of Chinese Medicine, 12 Airport Road, Baiyun District, Guangzhou, 510405, Guangdong, China.,Spine Surgery Department, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510407, China
| | - Yue-Rong Xu
- The 1St Institute of Clinical Medicine, Guangzhou University of Chinese Medicine, 12 Airport Road, Baiyun District, Guangzhou, 510405, Guangdong, China.,Spine Surgery Department, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510407, China
| | - Guo-Ye Mo
- The 1St Institute of Clinical Medicine, Guangzhou University of Chinese Medicine, 12 Airport Road, Baiyun District, Guangzhou, 510405, Guangdong, China.,Spine Surgery Department, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510407, China
| | - Yong-Chao Tang
- The 1St Institute of Clinical Medicine, Guangzhou University of Chinese Medicine, 12 Airport Road, Baiyun District, Guangzhou, 510405, Guangdong, China. .,Spine Surgery Department, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510407, China.
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Kim AYE, Lyons K, Sarmiento M, Lafage V, Iyer S. MRI-Based Score for Assessment of Bone Mineral Density in Operative Spine Patients. Spine (Phila Pa 1976) 2023; 48:107-112. [PMID: 36255388 DOI: 10.1097/brs.0000000000004509] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 09/30/2022] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective comparison. OBJECTIVE The aim was to determine whether a previously developed magnetic resonance imaging (MRI)-derived bone mineral density (BMD) scoring system can differentiate between healthy and osteoporotic vertebrae and to validate this scoring system against quantitative computed tomography measurements. SUMMARY OF BACKGROUND DATA BMD is an important preoperative consideration in spine surgery. Techniques to measure BMD are subject to falsely elevated values in the setting of spondylosis (dual-energy X-ray absorptiometry) or require significant exposure to radiation [quantitative computed tomography (QCT)]. Previous studies have shown that MRI may be utilized to measure bone quality using changes in the bone marrow signal observed on T1-weighted MRIs. MATERIALS AND METHODS Retrospective study of patients who underwent operative lumbar procedures at a single tertiary institution between 2016 and 2021 (n=61). Vertebral bone quality (VBQ) scores were measured by dividing the median signal intensities of L1-L4 by the signal intensity of cerebrospinal fluid on noncontrast T1W MRI. Demographic data, comorbidities, VBQ scores, and QCT-derived T scores and BMD of the lumbar spine were compared between healthy ( T score ≥-1; n=21), osteopenic (-2.5 < T score < -1; n=21), and osteoporotic ( T score ≤-2.5; n=19) cohorts using analysis of variance with post hoc Tukey test. Linear regression and receiver operating characteristic curve analyses were performed to assess the predictive value of VBQ scores. Pearson correlation test was used to evaluate the association between VBQ scores and QCT-derived measurements. RESULTS VBQ differentiated between healthy and osteoporotic groups ( P =0.009). Receiver operating characteristic curve analysis revealed that a greater VBQ score was associated with presence of osteoporosis (area under the curve=0.754, P =0.006). Cutoff VBQ for osteoporosis was 2.6 (Youden index 0.484; sensitivity: 58%; specificity: 90%). VBQ scores weakly correlated with QCT-derived BMD ( P =0.03, r =-0.27) and T scores ( P =0.04, r =-0.26). CONCLUSION This study attempted to further validate a previously developed MRI-based BMD scoring system against QCT-derived measurements. VBQ score was found to be a significant predictor of osteoporosis and could differentiate between healthy and osteoporotic vertebrae.
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Tian D, Liu J, Zhu B, Chen L, Jing J. Unilateral biportal endoscopic extreme transforaminal lumbar interbody fusion with large cage combined with endoscopic unilateral pedicle screw fixation for lumbar degenerative diseases: a technical note and preliminary effects. Acta Neurochir (Wien) 2023; 165:117-123. [PMID: 36418757 DOI: 10.1007/s00701-022-05422-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 11/06/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The purpose of the study was to investigate the feasibility and preliminary effects of unilateral biportal endoscopic extreme transforaminal lumbar interbody fusion(UBE-eXTLIF) with large cage combined with endoscopic unilateral pedicle screw fixation for lumbar degenerative diseases. METHODS Patients with lumbar degenerative diseases who received UBE-eXTLIF with large cage combined with endoscopic unilateral pedicle screw fixation from June 2022 to July 2022 were retrospectively analyzed, including 4 females and 1 males. The clinical symptoms and signs were consistent with the imaging changes. We recorded operation time, length of postoperative hospital stay, and complications. Visual Analogue Scale (VAS), Oswestry Disability Index (ODI), and modified Macnab scale was used to evaluate the clinical efficacy at preoperative, postoperative 1 month, and the last follow-up. RESULTS The operation was successfully completed in all cases. The operation time was 150-180 min, with an average of 164.60 ± 12.03 min. No serious complications such as dural tears and vascular and nerve injuries occurred during operation. All the patients got out of bed 1-3 days after surgery and were hospitalized 4-5 days after surgery, with an average of 4.20 ± 0.45 days. Preoperative VAS scores of low back pain were 6.20 ± 0.84 and respectively decreased to 2.20 ± 0.45 and 1.40 ± 0.55 at postoperative 1 month and at the last follow-up, and the difference was statistically significant (P < 0.05). Preoperative VAS scores of lower limb pain were 4.60 ± 2.61 and respectively decreased to 1.00 ± 0.71 and 0.60 ± 0.55 at postoperative 1 month and at the last follow-up, and the difference was statistically significant (P < 0.05). Preoperative ODI scores were 62.00 ± 3.16 and respectively decreased to 38.00 ± 1.41 and 32.40 ± 3.29 at postoperative 1 month and at the last follow-up, and the difference was statistically significant (P < 0.05). According to the modified Macnab criteria, the final outcome was excellent in 4 cases and good in 1 case. Five patients could return to normal activities within 3 weeks. CONCLUSIONS UBE-eXTLIF with large cage combined with endoscopic unilateral pedicle screw fixation can achieve excellent clinical results and may become a new minimally invasive endoscopic fusion method for lumbar degenerative diseases.
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Affiliation(s)
- Dasheng Tian
- Department of Orthopaedics & Spine Surgery, The Second Hospital of Anhui Medical University, Hefei, 230601, China
- Institute of Orthopaedics, Research Center for Translational Medicine, The Second Hospital of Anhui Medical University, Hefei, 230601, China
| | - Jianjun Liu
- Department of Orthopaedics & Spine Surgery, The Second Hospital of Anhui Medical University, Hefei, 230601, China
- Institute of Orthopaedics, Research Center for Translational Medicine, The Second Hospital of Anhui Medical University, Hefei, 230601, China
| | - Bin Zhu
- Department of Orthopaedics & Spine Surgery, The Second Hospital of Anhui Medical University, Hefei, 230601, China
- Institute of Orthopaedics, Research Center for Translational Medicine, The Second Hospital of Anhui Medical University, Hefei, 230601, China
| | - Lei Chen
- Department of Orthopaedics & Spine Surgery, The Second Hospital of Anhui Medical University, Hefei, 230601, China
- Institute of Orthopaedics, Research Center for Translational Medicine, The Second Hospital of Anhui Medical University, Hefei, 230601, China
| | - Juehua Jing
- Department of Orthopaedics & Spine Surgery, The Second Hospital of Anhui Medical University, Hefei, 230601, China.
- Institute of Orthopaedics, Research Center for Translational Medicine, The Second Hospital of Anhui Medical University, Hefei, 230601, China.
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Weng Y, Di M, Wu T, Ma X, Yang Q, Lu WW. Endplate volumetric bone mineral density biomechanically matched interbody cage. Front Bioeng Biotechnol 2022; 10:1075574. [PMID: 36561040 PMCID: PMC9763577 DOI: 10.3389/fbioe.2022.1075574] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 11/28/2022] [Indexed: 12/12/2022] Open
Abstract
Disc degenerative problems affect the aging population, globally, and interbody fusion is a crucial surgical treatment. The interbody cage is the critical implant in interbody fusion surgery; however, its subsidence risk becomes a remarkable clinical complication. Cage subsidence is caused due to a mismatch of material properties between the bone and implant, specifically, the higher elastic modulus of the cage relative to that of the spinal segments, inducing subsidence. Our recent observation has demonstrated that endplate volumetric bone mineral density (EP-vBMD) measured through the greatest cortex-occupied 1.25-mm height region of interest, using automatic phantomless quantitative computed tomography scanning, could be an independent cage subsidence predictor and a tool for cage selection instruction. Porous design on the metallic cage is a trend in interbody fusion devices as it provides a solution to the subsidence problem. Moreover, the superior osseointegration effect of the metallic cage, like the titanium alloy cage, is retained. Patient-specific customization of porous metallic cages based on the greatest subsidence-related EP-vBMD may be a good modification for the cage design as it can achieve biomechanical matching with the contacting bone tissue. We proposed a novel perspective on porous metallic cages by customizing the elastic modulus of porous metallic cages by modifying its porosity according to endplate elastic modulus calculated from EP-vBMD. A three-grade porosity customization strategy was introduced, and direct porosity-modulus customization was also available depending on the patient's or doctor's discretion.
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Affiliation(s)
- Yuanzhi Weng
- Department of Orthopaedics and Traumatology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR, China,Department of Orthopaedics and Traumatology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Mingyuan Di
- Graduate School, Tianjin Medical University, Tianjin, China,Department of Spine Surgery, Tianjin Hospital, Tianjin University, Tianjin, China
| | - Tianchi Wu
- Department of Orthopaedics and Traumatology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR, China,Department of Orthopaedics and Traumatology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Xinlong Ma
- Tianjin Hospital, Tianjin University, Tianjin, China
| | - Qiang Yang
- Department of Spine Surgery, Tianjin Hospital, Tianjin University, Tianjin, China,*Correspondence: Qiang Yang, ; Weijia William Lu,
| | - Weijia William Lu
- Department of Orthopaedics and Traumatology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR, China,Department of Orthopaedics and Traumatology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China,Research Center for Human Tissue and Organs Degeneration, Institute of Biomedicine and Biotechnology, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences (CAS), Shenzhen, China,*Correspondence: Qiang Yang, ; Weijia William Lu,
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Hu YH, Yeh YC, Niu CC, Hsieh MK, Tsai TT, Chen WJ, Lai PL. Novel MRI-based vertebral bone quality score as a predictor of cage subsidence following transforaminal lumbar interbody fusion. J Neurosurg Spine 2022; 37:654-662. [PMID: 35561693 DOI: 10.3171/2022.3.spine211489] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 03/31/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Decreased bone mineral density as measured by dual-energy x-ray absorptiometry (DEXA) has been reported to be associated with cage subsidence following transforaminal lumbar interbody fusion (TLIF). However, DEXA is not often available or routinely performed before surgery. A novel MRI-based vertebral bone quality (VBQ) score has been developed and reported to be correlated with DEXA T-scores. The authors investigated the ability of the VBQ score to predict cage subsidence and other risk factors associated with this complication. METHODS In this retrospective study, the authors reviewed the records of patients who had undergone single-level TLIF from March 2014 to October 2015 and had a follow-up of more than 2 years. Cage subsidence was measured as postoperative disc height loss and was graded according to the system proposed by Marchi et al. The MRI-based VBQ score was measured on T1-weighted images. Univariable analysis and multivariable binary logistic regression analysis were performed. Ad hoc analysis with receiver operating characteristic curve analysis was performed to assess the predictive ability of the significant continuous variables. Additional analyses were used to determine the correlations between the VBQ score and T-scores and between the significant continuous variables and the amount of cage subsidence. RESULTS Among 242 patients eligible for study inclusion, 111 (45.87%) had cage subsidence after the index operation. Multivariable logistic regression analyses demonstrated that an increased VBQ score (OR 14.615 ± 0.377, p < 0.001), decreased depth ratio (OR 0.011 ± 1.796, p = 0.013), and the use of kidney-shaped cages instead of bullet-shaped cages (OR 2.766 ± 0.358, p = 0.008) were associated with increased cage subsidence. The VBQ score was shown to significantly predict cage subsidence with an accuracy of 85.6%. The VBQ score was found to be moderately correlated with DEXA T-scores of the total hip (r = -0.540, p < 0.001) and the lumbar spine (r = -0.546, p < 0.001). The amount of cage subsidence was moderately correlated with the VBQ score (r = 0.512, p < 0.001). CONCLUSIONS Increased VBQ scores, posteriorly placed cages, and kidney-shaped cages were risk factors for cage subsidence. The VBQ score was shown to be a good predictor of cage subsidence, was moderately correlated with DEXA T-scores for the total hip and lumbar spine, and also had a moderate correlation with the amount of cage subsidence.
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Affiliation(s)
- Yung-Hsueh Hu
- 1Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Linkou
- 2Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou
- 3College of Medicine, Chang Gung University, Taoyuan; and
| | - Yu-Cheng Yeh
- 1Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Linkou
- 2Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou
- 3College of Medicine, Chang Gung University, Taoyuan; and
| | - Chi-Chien Niu
- 1Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Linkou
- 2Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou
- 3College of Medicine, Chang Gung University, Taoyuan; and
| | - Ming-Kai Hsieh
- 1Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Linkou
- 2Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou
- 3College of Medicine, Chang Gung University, Taoyuan; and
| | - Tsung-Ting Tsai
- 1Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Linkou
- 2Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou
- 3College of Medicine, Chang Gung University, Taoyuan; and
| | - Wen-Jer Chen
- 4Department of Orthopedic Surgery, Chung Shan Hospital, Taipei, Taiwan
| | - Po-Liang Lai
- 1Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Linkou
- 2Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou
- 3College of Medicine, Chang Gung University, Taoyuan; and
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Singhatanadgige W, Tangchitcharoen N, Kerr SJ, Tanasansomboon T, Yingsakmongkol W, Kotheeranurak V, Limthongkul W. A Comparison of Polyetheretherketone and Titanium-Coated Polyetheretherketone in Minimally Invasive Transforaminal Lumbar Interbody Fusion: A Randomized Clinical Trial. World Neurosurg 2022; 168:e471-e479. [DOI: 10.1016/j.wneu.2022.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 10/01/2022] [Accepted: 10/03/2022] [Indexed: 11/07/2022]
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Shi H, Wang XH, Zhu L, Chen L, Jiang ZL, Wu XT. Intraoperative Endplate Injury Following Transforaminal Lumbar Interbody Fusion. World Neurosurg 2022; 168:e110-e118. [PMID: 36122858 DOI: 10.1016/j.wneu.2022.09.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Revised: 09/11/2022] [Accepted: 09/12/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To investigate the incidence, distribution characteristics, risk factors, and clinical outcomes of intraoperative endplate injury following transforaminal lumbar interbody fusion (TLIF). METHODS Patients who underwent single-level TLIF from January 2018 to December 2020 were included. The patients were separated into endplate injury group (EI group) and no endplate injury group (non-EI group) by postoperative computed tomography scanning immediately. All patients' demographic, clinical, and radiographic parameters were analysed. Clinical outcomes were evaluated by visual analogue scale (VAS) for low back pain and Oswestry Disability Index (ODI). RESULTS 576 patients were enrolled in this study. The rates of endplate injury were 19.6% (113 of 576) of patients and 9.9% (114 of 1152) of endplates. The rate of superior endplate injury was significantly higher than that of inferior endplate injury. The results illustrated that older age, lower disc height index (DHI), and taller cage height were independent risk factors for intraoperative endplate injury. The postoperative drain output, total blood loss, postoperative duration of drainage tube, and postoperative hospital stay in EI group were significantly more than those in non-EI group. There were no statistical differences in ODI and VAS scores at the same time point between two groups. CONCLUSIONS The rates of endplate injury were 19.6% of patients and 9.9% of endplates. The superior endplates are more susceptible to injury than inferior endplates. Older age, lower DHI, and taller cage height were independent risk factors for intraoperative endplate injury. Clinical outcomes were not affected by intraoperative endplate injury during early postoperative follow-up.
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Affiliation(s)
- Hang Shi
- Department of Spine Surgery, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Xiao-Hu Wang
- Department of Spine Surgery, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Lei Zhu
- Department of Spine Surgery, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Lu Chen
- Department of Spine Surgery, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Zan-Li Jiang
- Department of Spine Surgery, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Xiao-Tao Wu
- Department of Spine Surgery, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China.
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Ge T, Xu Z, Wu J, Sun Y. Pear-Shaped Disk as a Risk Factor for Intraoperative End Plate Injury in Oblique Lumbar Interbody Fusion. World Neurosurg 2022; 165:e43-e50. [PMID: 35577206 DOI: 10.1016/j.wneu.2022.05.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 05/08/2022] [Accepted: 05/09/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Intraoperative end plate injury can result in late-onset cage subsidence in oblique lumbar interbody fusion (OLIF). This study aimed to identify risk factors for intraoperative end plate injury and investigate whether a pear-shaped disk correlated with intraoperative end plate injury in OLIF. METHODS We retrospectively reviewed 102 levels in 82 patients (mean age 60.1 ± 10.0 years) who underwent OLIF for degenerative lumbar diseases. Intraoperative end plate injury was evaluated using midline sagittal computed tomography views at 3 days postoperatively and defined as cage breaching into an adjacent cortical end plate >2 mm. Patient demographics, surgical parameters, radiographic parameters, and cage-related parameters were recorded in all surgical levels. Evaluation of risk factors associated with intraoperative end plate injury was performed. Patient-reported outcome, fusion status, and late-onset cage subsidence were analyzed at a minimum of 1 year after the surgery. RESULTS Intraoperative end plate injury was observed in 26 levels (25.5%). Multivariate logistic regression analysis identified that bone mineral density (odds ratio [OR] = 0.978), preoperative segmental lordosis (OR = 0.790), and pear-shaped disk were risk factors (OR = 5.837) for intraoperative end plate injury. Intraoperative end plate injury occurred in 45.5% of levels with a pear-shaped disk compared with 16.0% of levels with no pear-shaped disk (P < 0.01). Late-onset cage subsidence was significantly more frequent in the injury group than the no-injury group. Patient-reported outcome and fusion status were unrelated to intraoperative end plate injury. CONCLUSIONS A pear-shaped disk is the greatest risk factor for intraoperative end plate injury following OLIF.
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Affiliation(s)
- Tenghui Ge
- Department of Spine Surgery, Peking University Fourth School of Clinical Medicine, Beijing Jishuitan Hospital, Beijing, People's Republic of China
| | - Zhongning Xu
- Department of Spine Surgery, Peking University Fourth School of Clinical Medicine, Beijing Jishuitan Hospital, Beijing, People's Republic of China
| | - Jingye Wu
- Department of Spine Surgery, Peking University Fourth School of Clinical Medicine, Beijing Jishuitan Hospital, Beijing, People's Republic of China
| | - Yuqing Sun
- Department of Spine Surgery, Peking University Fourth School of Clinical Medicine, Beijing Jishuitan Hospital, Beijing, People's Republic of China.
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Xie T, Pu L, Zhao L, Lu Y, Yang Z, Wang X, Song Y, Zeng J. Influence of coronal-morphology of endplate and intervertebral space to cage subsidence and fusion following oblique lumbar interbody fusion. BMC Musculoskelet Disord 2022; 23:633. [PMID: 35788206 PMCID: PMC9252057 DOI: 10.1186/s12891-022-05584-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Accepted: 06/24/2022] [Indexed: 02/08/2023] Open
Abstract
Background Endplate morphology is considered to be one of the influencing factors of cage subsidence after lumbar interbody fusion (LIF). Previous radiographic evaluations on the endplate mostly used sagittal X-ray or MRI. However, there are few studies on the CT evaluation of the endplate and intervertebral space (IVS), especially the evaluation of coronal morphology and its influence on subsidence and fusion after LIF. We aimed to measure and classify the shapes of the endplate and IVS using coronal CT imaging and evaluate the radiographic and clinical outcomes of different shapes of the endplate/IVS following oblique lateral lumbar interbody fusion (OLIF). Methods A total of 137 patients (average age 59.1 years, including 75 males and 62 females) who underwent L4-5 OLIF combined with anterolateral fixation from June 2018 to June 2020 were included. The endplate concavity depth (ECD) was measured on the preoperative coronal CT image. According to ECD, the endplate was classified as flat (< 2 mm), shallow (2–4 mm), or deep (> 4 mm). The L4-5 IVS was further classified according to endplate type. The disc height (DH), DH changes, subsidence rate, fusion rate, and Oswestry Disability Index (ODI) in different endplate/IVS shapes were evaluated during 1-year follow up. Results The ECD of L4 inferior endplate (IEP) was significantly deeper than that of L5 superior endplate (SEP) (4.2 ± 1.1 vs 1.6 ± 0.8, P < 0.01). Four types of L4-5 IVS were identified: shallow-shallow (16, 11.7%), shallow-flat (45, 32.9%), deep-shallow (32, 23.4%), and deep-flat (44, 32.1%). A total of 45 (32.9%) cases of cage subsidence were observed. Only one (6.3%) subsidence event occurred in the shallow-shallow group, which was significantly lower than in the other three groups (19 shallow-flat, 6 deep-shallow, and 19 deep-flat) (P < 0.05). Meanwhile, the shallow-shallow group had the highest fusion rate (15, 93.8%) and the highest rate of reach minimal clinically important difference (MCID) ODI among the four types. For a single endplate, the shape of L4 IEP is the main influencing factor of the final interbody fusion rate, and the shallow shape L4 IEP facilitates fusion ( OR = 2.85, p = 0.03). On the other hand, the flat shape L5 SEP was the main risk factor to cage subsidence (OR = 4.36, p < 0.01). Conclusion The L4-5 IVS is asymmetrical on coronal CT view and tends to be fornix-above and flat-down. The shallow-shallow IVS has the lowest subsidence rate and best fusion result, which is possibly because it has a relatively good degree in matching either the upper or lower interface of the cage and endplates. These findings provide a basis for the further improvements in the design of OLIF cages. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-022-05584-3.
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Affiliation(s)
- Tianhang Xie
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, 37# Wuhou Guoxue road, Chengdu, 610041, China
| | - Liming Pu
- Department of Medical Statistics, School of Public Health, Sun Yat-Sen University, Guangzhou, China
| | - Long Zhao
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, 37# Wuhou Guoxue road, Chengdu, 610041, China
| | - Yufei Lu
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, 37# Wuhou Guoxue road, Chengdu, 610041, China
| | - Zhiqiang Yang
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, 37# Wuhou Guoxue road, Chengdu, 610041, China
| | - Xiandi Wang
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, 37# Wuhou Guoxue road, Chengdu, 610041, China
| | - Yueming Song
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, 37# Wuhou Guoxue road, Chengdu, 610041, China
| | - Jiancheng Zeng
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, 37# Wuhou Guoxue road, Chengdu, 610041, China.
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Does Preoperative Bone Mineral Density Impact Fusion Success in Anterior Cervical Spine Surgery? A Prospective Cohort Study. World Neurosurg 2022; 164:e830-e834. [PMID: 35605943 DOI: 10.1016/j.wneu.2022.05.058] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 05/12/2022] [Accepted: 05/13/2022] [Indexed: 11/20/2022]
Abstract
OBJECTIVE The purpose of this study was to identify risk factors for pseudarthrosis in patients undergoing anterior cervical discectomy and fusion (ACDF) with a focus on the role of bone mineral density (BMD) on arthrodesis. METHODS We retrospectively reviewed a prospectively collected database of patients undergoing 1- to 4-level ACDF for degenerative indications between 2012 and 2018 at a single institution. All patients were required to have undergone a preoperative dual-energy x-ray absorptiometry (DEXA) scan. Fusion status was assessed on computed tomography (CT) scans obtained 1 year postoperatively. Patients were divided into subgroups based on fusion status and compared on the basis of demographic, BMD, and surgical variables to determine risk factors for pseudarthrosis. RESULTS We identified 79 patients for inclusion in this study. Fusion was achieved in 65 patients (82%), while 14 patients (18%) developed pseudarthrosis. The pseudarthrosis subgroup demonstrated significantly lower BMD than their counterparts who achieved successful fusion in both mean hip (-1.4 ± 1.2 vs. -0.2 ± 1.2, respectively; P = 0.002) and spine T-scores (-0.8 ± 1.8 vs. 0.6 ± 1.9, respectively; P = 0.02). The pseudarthrosis group had a substantially higher proportion of patients with osteopenia (57.1% vs. 20.0%) and osteoporosis (21.5% vs. 6.2%; P < 0.001) than the fusion group. Multivariate analysis demonstrated osteopenia (odds ratio [OR] 8.76, P = 0.04), osteoporosis (OR 9.97, P = 0.03), and low BMD (OR 11.01, P = 0.002) to be associated with an increased likelihood of developing pseudarthrosis. CONCLUSIONS The results of this study suggest that both osteopenia and osteoporosis are associated with increased rates of pseudarthrosis in patients undergoing elective ACDF.
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Eum JH, Park JH, Song KS, Lee SM, Suh DW, Jo DJ. Endoscopic Extreme Transforaminal Lumbar Interbody Fusion With Large Spacers: A Technical Note and Preliminary Report. Orthopedics 2022; 45:163-168. [PMID: 35112965 DOI: 10.3928/01477447-20220128-07] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
This report describes a novel endoscopic fusion technique performed with unilateral biportal endoscopy (UBE) that is known as extreme transforaminal lumbar interbody fusion (eXTLIF) and is performed with a large spacer. We also present the short-term results of this procedure. Previous studies reported that minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) could achieve acceptable rates of fusion; therefore, it is often used for treating various degenerative lumbar diseases. Moreover, MIS-TLIF can be performed with a unilateral approach; hence, it is commonly performed with the UBE technique. The biportal endoscopic TLIF procedure is usually performed with a single spacer in the interbody space. It is important to insert the maximum amount of graft material into the preparation site via an autologous bone marrow transplant or any other suitable substance with spacer insertion. Because MIS-TLIF with UBE is performed in water, it might provide an inadequate environment for excellent fusion. Therefore, a modified method was used to increase the surface contact area and insert the maximum amount of bone material with a larger spacer. However, the use of a large spacer necessitates a larger spacer orifice. For this purpose, eXTLIF was performed, which inserts the spacer more laterally compared with the current TLIF position. We report the surgical method and short-term results, which have been satisfactory thus far. [Orthopedics. 2022;45(3):163-168.].
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Huang J, Rabin EE, Stricsek GP, Swong KN. Outcomes and complications of minimally invasive transforaminal lumbar interbody fusion in the elderly: a systematic review and meta-analysis. J Neurosurg Spine 2022; 36:741-752. [PMID: 34767529 DOI: 10.3171/2021.7.spine21829] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 07/26/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) may be used to treat degenerative spinal pathologies while reducing risks associated with open procedures. As an increasing number of lumbar fusions are performed in the aging United States population, MIS-TLIF has been widely adopted into clinical practice in recent years. However, its complication rate and functional outcomes in elderly patients remain poorly characterized. The objective of this study was to assess complication rates and functional outcomes in elderly patients (≥ 65 years old) undergoing MIS-TLIF. METHODS The PubMed, Embase, and Scopus databases were searched for relevant records in accordance with the PRISMA guidelines. Inclusion criteria were peer-reviewed original research; English language; full text available; use of MIS-TLIF; and an elderly cohort of at least 5 patients. Risk of bias was assessed using the ROBINS-I (Risk of Bias in Nonrandomized Studies-of Interventions) tool. Pooled complication rates were calculated for elderly patients, with subgroup analyses performed for single versus multiple-level fusions. Complication rates in elderly compared to nonelderly patients were also assessed. Postoperative changes in patient-reported outcomes, including Oswestry Disability Index (ODI) and visual analog scale (VAS) back pain (BP) and leg pain (LP) scores, were calculated. RESULTS Twelve studies were included in the final analysis. Compared to nonelderly patients, MIS-TLIF in elderly patients resulted in significantly higher rates of major (OR 2.15, 95% CI 1.07-4.34) and minor (OR 2.20, 95% CI 1.22-3.95) complications. The pooled major complication rate in elderly patients was 0.05 (95% CI 0.03-0.08) and the pooled minor complication rate was 0.20 (95% CI 0.13-0.30). Single-level MIS-TLIF had lower major and minor complication rates than multilevel MIS-TLIF, although not reaching significance. At a minimum follow-up of 6 months, the postoperative change in ODI (-30.70, 95% CI -41.84 to -19.55), VAS-BP (-3.87, 95% CI -4.97 to -2.77), and VAS-LP (-5.11, 95% CI -6.69 to -3.53) in elderly patients all exceeded the respective minimum clinically important difference. The pooled rate of fusion was 0.86 (95% CI 0.80-0.90). CONCLUSIONS MIS-TLIF in elderly patients results in a high rate of fusion and significant improvement of patient-reported outcomes, but has significantly higher complication rates than in nonelderly patients. Limitations of this study include heterogeneity in the definition of elderly and limited reporting of risk factors among included studies. Further study of the impact of complications and the factors predisposing elderly patients to poor outcomes is needed.
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Yu Y, Robinson DL, Ackland DC, Yang Y, Lee PVS. Influence of the geometric and material properties of lumbar endplate on lumbar interbody fusion failure: a systematic review. J Orthop Surg Res 2022; 17:224. [PMID: 35399075 PMCID: PMC8996478 DOI: 10.1186/s13018-022-03091-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 03/22/2022] [Indexed: 11/12/2022] Open
Abstract
Background Lumbar interbody fusion (LIF) is an established surgical intervention for patients with leg and back pain secondary to disc herniation or degeneration. Interbody fusion involves removal of the herniated or degenerated disc and insertion of interbody devices with bone grafts into the remaining cavity. Extensive research has been conducted on operative complications such as a failure of fusion or non-union of the vertebral bodies. Multiple factors including surgical, implant, and patient factors influencing the rate of complications have been identified. Patient factors include age, sex, osteoporosis, and patient anatomy. Complications can also be influenced by the interbody cage design. The geometry of the bony endplates as well as their corresponding material properties guides the design of interbody cages, which vary considerably across patients with spinal disorders. However, studies on the effects of such variations on the rate of complications are limited. Therefore, this study aimed to perform a systematic review of lumbar endplate geometry and material property factors in LIF failure. Methods Search keywords included ‘factor/cause for spinal fusion failure/cage subsidence/cage migration/non-union’, ‘lumbar’, and ‘interbody’ in electronic databases PubMed and Scopus with no limits on year of publication. Results In total, 1341 articles were reviewed, and 29 articles were deemed suitable for inclusion. Adverse events after LIF, such as cage subsidence, cage migration, and non-union, resulted in fusion failure; hence, risk factors for adverse events after LIF, notably those associated with lumbar endplate geometry and material properties, were also associated with fusion failure. Those risk factors were associated with shape, concavity, bone mineral density and stiffness of endplate, segmental disc angle, and intervertebral disc height. Conclusions This review demonstrated that decreased contact areas between the cage and endplate, thin and weak bony endplate as well as spinal diseases such as spondylolisthesis and osteoporosis are important causes of adverse events after LIF. These findings will facilitate the selection and design of LIF cages, including customised implants based on patient endplate properties. Supplementary Information The online version contains supplementary material available at 10.1186/s13018-022-03091-8.
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Zhao L, Xie T, Wang X, Yang Z, Pu X, Lu Y, Zeng J. Clinical and radiological evaluation of cage subsidence following oblique lumbar interbody fusion combined with anterolateral fixation. BMC Musculoskelet Disord 2022; 23:214. [PMID: 35248042 PMCID: PMC8898418 DOI: 10.1186/s12891-022-05165-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Accepted: 02/22/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Cage subsidence (CS) was previously reported as one of the most common complications following oblique lumbar interbody fusion (OLIF). We aimed to assess the impacts of CS on surgical results following OLIF combined with anterolateral fixation, and determine its radiological characteristics as well as related risk factors.
Methods
Two hundred and forty-two patients who underwent OLIF at L4-5 and with a minimum 12 months follow-up were reviewed. Patients were divided into three groups according to the extent of disk height (DH) decrease during follow-up: no CS (DH decrease ≤ 2 mm), mild CS (2 mm < DH decrease ≤ 4 mm) and severe CS (DH decrease > 4 mm). The clinical and radiological results were compared between groups to evaluate radiological features, clinical effects and risk factors of CS.
Results
CS was identified in 79 (32.6%) patients, including 48 (19.8%) with mild CS and 31 (11.8%) with severe CS. CS was mainly identified within 1 month postoperatively, it did not progress after 3 months postoperatively, and more noted in the caudal endplate (44, 55.7%). In terms of clinical results, patients in the mild CS group were significantly worse than those in the no CS group, and patients in the severe CS group were significantly worse than those in the mild CS group. There was no significant difference in fusion rate between no CS (92.6%, 151/163) and mild CS (83.3%, 40/48) groups. However, significant lower fusion rate was observed in severe CS group (64.5%, 20/31) compared to no CS group. CS related risk factors included osteoporosis (OR = 5.976), DH overdistraction (OR = 1.175), flat disk space (OR = 3.309) and endplate injury (OR = 6.135).
Conclusion
CS following OLIF was an early postoperative complication. Higher magnitudes of CS were associated with worse clinical improvements and lower intervertebral fusion. Osteoporosis and endplate injury were significant risk factors for CS. Additionally, flat disk space and DH over-distraction were also correlated with an increased probability of CS.
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Guha D, Mushlin HM, Muthiah N, Vodovotz LL, Agarwal N, Alan N, Hamilton DK, Okonkwo DO, Kanter AS. CT Hounsfield Units as a predictor of reoperation and graft subsidence following standalone and multi-level lateral lumbar interbody fusion. World Neurosurg 2022; 161:e417-e426. [PMID: 35149250 DOI: 10.1016/j.wneu.2022.02.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 02/02/2022] [Accepted: 02/03/2022] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Standalone single and multi-level lateral lumbar interbody fusion (LLIF) are increasingly being applied to treat degenerative spinal conditions in a less invasive fashion. Graft subsidence following LLIF is a known complication and has been associated with poor bone mineral density (BMD). Previous research has demonstrated the utility of CT Hounsfield Units (HU) as a surrogate for BMD. This study aims to investigate the relationship between CT HU and subsidence and reoperation after standalone and multi-level LLIF. METHODS A prospectively-maintained single-institution database was retrospectively reviewed for LLIF patients from 2017-2020 including single and multi-level standalone cases with or without supplemental posterior fixation. Data on demographics, graft parameters, BMD on DEXA, preoperative mean segmental CT HU, and postoperative subsidence and reoperation, were collected. Three-foot standing radiographs were used to measure preoperative global sagittal alignment and disc height, and subsidence at last follow-up. Subsidence was classified using the Marchi grading system corresponding to disc height loss: Grade 0: 0-24%; I: 25-49%; II: 50-74%; III: 75-100%. RESULTS Eighty-nine LLIF patients met study criteria, with mean follow-up 19.9 ± 13.9 months. Among the 54 patients who underwent single-level LLIF, mean segmental HU was 152.0 ± 8.7 in 39 patients with Grade 0 subsidence, 136.7 ± 10.4 in nine with Grade I subsidence, 133.9 ± 23.1 in three with Grade II subsidence, and 119.9 ± 30.9 in three with Grade III subsidence (p=0.032). In the 96 instrumented levels in 35 patients who underwent multi-level LLIF, 85 had Grade 0 subsidence, 9 Grade I, 1 Grade II, and 1 Grade III, with no differences in HU. In multivariate logistic regression, increased CT HU was independently associated with a decreased risk of reoperation in both single-level and multi-level LLIF (OR:0.98, 95%CI:0.97-0.99, p=0.044; and OR:0.97, 95%CI: 0.94-0.99, p=0.017, respectively). Overall BMD on DEXA was not associated with graft subsidence nor reoperation. Using a receiver-operating-characteristic curve to establish separation between patients requiring reoperation and those that did not, the determined threshold HU for single-level LLIF was 131.4 (sensitivity 0.62, specificity 0.65), and for multi-level was 131.0 (sensitivity 0.67, specificity 0.63). CONCLUSIONS Lower CT HU are independently associated with an increased risk of graft subsidence following single-level LLIF. In addition, lower CT HU significantly increased the risk of reoperation in both single and multi-level LLIF with a critical threshold of 131 HU. Preoperative CT HU may provide a more robust gauge of local bone quality and the likelihood of graft subsidence requiring reoperation following LLIF, than overall BMD.
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Affiliation(s)
- Daipayan Guha
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA; Division of Neurosurgery, McMaster University, Hamilton, Ontario, Canada.
| | - Harry M Mushlin
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Nallammai Muthiah
- Faculty of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Lena L Vodovotz
- Faculty of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Nitin Agarwal
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Nima Alan
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - D Kojo Hamilton
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA; Faculty of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - David O Okonkwo
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA; Faculty of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Adam S Kanter
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA; Faculty of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Ding H, Hai Y, Liu Y, Guan L, Pan A, Zhang X, Han B, Li Y, Yin P. Cortical Trajectory Fixation Versus Traditional Pedicle-Screw Fixation in the Treatment of Lumbar Degenerative Patients with Osteoporosis: A Prospective Randomized Controlled Trial. Clin Interv Aging 2022; 17:175-184. [PMID: 35237030 PMCID: PMC8882472 DOI: 10.2147/cia.s349533] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 01/31/2022] [Indexed: 12/11/2022] Open
Abstract
Study Design Objective Methods Results Conclusion Trial Registration Number Date of Registration
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Affiliation(s)
- Hongtao Ding
- Department of Spine Surgery, Beijing Chao-Yang Hospital, Capital Medical University of China, Beijing, People’s Republic of China
| | - Yong Hai
- Department of Spine Surgery, Beijing Chao-Yang Hospital, Capital Medical University of China, Beijing, People’s Republic of China
- Correspondence: Yong Hai; Yuzeng Liu, Department of Spine Surgery, Beijing Chao-Yang Hospital, Capital Medical University of China, Beijing, People’s Republic of China, Tel +86 10-85231229; +86 13801221889; +86 13811552832, Email ; ;
| | - Yuzeng Liu
- Department of Spine Surgery, Beijing Chao-Yang Hospital, Capital Medical University of China, Beijing, People’s Republic of China
| | - Li Guan
- Department of Spine Surgery, Beijing Chao-Yang Hospital, Capital Medical University of China, Beijing, People’s Republic of China
| | - Aixing Pan
- Department of Spine Surgery, Beijing Chao-Yang Hospital, Capital Medical University of China, Beijing, People’s Republic of China
| | - Xinuo Zhang
- Department of Spine Surgery, Beijing Chao-Yang Hospital, Capital Medical University of China, Beijing, People’s Republic of China
| | - Bo Han
- Department of Spine Surgery, Beijing Chao-Yang Hospital, Capital Medical University of China, Beijing, People’s Republic of China
| | - Yue Li
- Department of Spine Surgery, Beijing Chao-Yang Hospital, Capital Medical University of China, Beijing, People’s Republic of China
| | - Peng Yin
- Department of Spine Surgery, Beijing Chao-Yang Hospital, Capital Medical University of China, Beijing, People’s Republic of China
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Li Q, Long X, Shi L, Wang Y, Guan T, Lv J, Cai L. Prevalence and risk factors for cage subsidence after lumbar interbody fusion: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2021; 100:e28085. [PMID: 34889258 PMCID: PMC8663804 DOI: 10.1097/md.0000000000028085] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 11/15/2021] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION Lumbar interbody fusion (LIF) is an effective treatment for lumbar degenerative diseases. Cage subsidence (CS) contitutes one of the most common postoperative complications. Many risk factors for CS after LIF have been reported in some studies. However, controversies still exist. The objective of this study will be to summarize data on the prevalence and risk factors of CS after LIF. METHODS AND ANALYSIS Our study present a protocol that conducted a systematic review and meta-analysis of prevalence and risk factors for CS after LIF. Two reviewers retrieved the relevant articles using the 5 databases (PubMed, Scopus, EMBASE, Cochrane Library, and Web of Science) from inception to May 31st, 2021. Primary outcome will be the prevalence of CS after LIF. Second outcomes include the risk factors associated with postoperative CS and clinical outcomes associated with postoperative CS. Three reviewers will screen citation titles and abstracts and evaluated full-text of each potentially relevant citation, and then extracted the data using a data extraction form. Any discrepancies in decisions between reviewers will be resolved through discussion. We assessed the methodological quality and risk of bias of the included studies based on the Newcastle-Ottawa Quality Assessment Scale (NOS). The aim of the extra analysis is to explore the explanations of the heterogeneity (age, gender, race, year of publication, type of study and surgical procedure). Publication bias will be assessed by Begg test, Egger test and funnel plots. ETHICS AND DISSEMINATION No primary data will be collected and individual patient information and endangering participant rights, thus ethics approval is not required. Findings will be reported through publication and media. PROTOCOL REGISTRATION NUMBER PROSPERO CRD42021257981 (https://www.crd.york.ac.uk/PROSPERO/#joinuppage).
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Affiliation(s)
- Qiujiang Li
- Ningxia Medical University, Yinchuan, Ningxia, China
- Department of Orthopedics, People's Hospital of Ningxia Hui Autonomous Region, Yinchuan, Ningxia, China
| | - Xingxia Long
- West China Hospital, Sichuan University, Sichuan, China
| | - Lin Shi
- Traditional Chinese Medicine Hospital Dianjiang Chongqing, Chongqing, China
| | - Yinbin Wang
- Department of Orthopedics, People's Hospital of Ningxia Hui Autonomous Region, Yinchuan, Ningxia, China
| | - Tao Guan
- Department of Orthopedics, People's Hospital of Ningxia Hui Autonomous Region, Yinchuan, Ningxia, China
| | - Jinhan Lv
- Department of Orthopedics, People's Hospital of Ningxia Hui Autonomous Region, Yinchuan, Ningxia, China
| | - Lijun Cai
- Department of Orthopedics, People's Hospital of Ningxia Hui Autonomous Region, Yinchuan, Ningxia, China
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Hyakkan R, Kanayama M, Takahata M, Oha F, Hashimoto T, Iwasaki N. Bone Metabolism in the Healing Process of Lumbar Interbody Fusion: Temporal Changes of Bone Turnover Markers. Spine (Phila Pa 1976) 2021; 46:1645-1652. [PMID: 33882539 DOI: 10.1097/brs.0000000000004075] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Prospective longitudinal study. OBJECTIVE The aim of this study was to evaluate temporal changes of bone turnover markers (BTMs) after lumbar spinal fusion in patients without osteoporosis. SUMMARY OF BACKGROUND DATA Radiological studies are the standard method to monitor bony fusion, but they do not allow a timely assessment of bone healing. BTMs react rapidly to changes in bone metabolism during fusion process and could be an additional tool to monitor this process. METHODS A total of 78 nonosteoporosis patients who had undergone one- or two-level transforaminal lumbar interbody fusion were included. Fusion status was assessed using computed tomography sagittal and coronal images. Serum levels of bone-specific alkaline phosphatase (BAP), procollagen type 1 amino-terminal propeptide (P1NP), and osteocalcin (OC) were measured to assess bone formation, and tartrate-resistant acid phosphatase 5b (TRACP-5b) was measured to assess bone resorption. Serum samples were obtained before surgery and at 1, 2, 4, 8, 13, 26, 39, and 52 weeks after surgery. RESULTS A solid fusion was achieved in 71 of 78 patients (91%), and seven patients resulted in pseudarthrosis. In the fusion group, the level of all BTMs once decreased at 1 postoperative week. Then, BAP and P1NP reached a peak at 4 weeks after surgery, and TRACP-5b and OC peaked at 8 weeks. Thereafter, the level of P1NP and TRACP-5b gradually got closer to the baseline over a year, and BAP kept high until 52 postoperative weeks. In the pseudarthrosis group, peak level of BTMs was significantly higher and the increased level of BAP and P1NP was kept until 52 weeks. CONCLUSION The present study demonstrated dynamics of BTMs after lumbar spinal fusion in patients without osteoporosis. These normal population data contribute as a baseline to evaluate the effect of osteogenic agents on bone metabolism after spinal fusion.Level of Evidence: 2.
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Affiliation(s)
- Ryota Hyakkan
- Spine Center, Hakodate Central General Hospital, Hakodate, Japan
| | | | - Masahiko Takahata
- Department of Orthopedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Fumihiro Oha
- Spine Center, Hakodate Central General Hospital, Hakodate, Japan
| | | | - Norimasa Iwasaki
- Department of Orthopedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
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Li H, Xu ZK, Zhang N, Li F, Chen Q. Incidence and risk factors of lateral cage migration occurred after the first-stage lateral lumbar interbody fusion surgery. Orthop Traumatol Surg Res 2021; 107:103033. [PMID: 34358711 DOI: 10.1016/j.otsr.2021.103033] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 02/08/2021] [Accepted: 05/14/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Lateral lumbar interbody fusion (LLIF) is a novel, minimally invasive technique for the surgical treatment of lumbar diseases. The aim of this study was to identify the incidence and risk factors of lateral cage migration (LCM) occurred after the first-stage LLIF. HYPOTHESIS The hypothesis was that LCM occurred after the first-stage LLIF was associated with some demographic characteristics, surgical variables and radiographic parameters. PATIENTS AND METHODS Between June 2016 and August 2020, 335 patients (901 levels) underwent staged LLIF were retrospectively reviewed. Patients were classified into LCM and non-LCM group based on the experience of LCM before the second-stage posterior instrumentation. 100 patients in non-LCM were randomly sampled as a control group. Incidence of LCM was determined; demographic characteristics, surgical variables and radiographic parameters associated with LCM were compared between the LCM and control group. Univariate analyses and multivariable logistic regression analysis were used to identify the risk factors. RESULTS LCM occurred after the first-stage LLIF was found in 19 (5.7%) patients. Bony endplate injury (OR, 106.255; 95% CI, 1.265-8924.765; p=0.039) and greater preoperative range of motion (ROM) (OR, 2.083, 95% CI, 1.068-4.066, p=0.031) were high risk factors for LCM. LCM occurred mainly 3 days later after the first-stage LLIF, while 4 cases experienced severe neural symptoms, intolerable low back pain and finally underwent reoperation. DISCUSSION LCM occurred after the first-stage LLIF was significantly associated with bony endplate injury and greater preoperative ROM. Second-stage posterior fixation should be performed as soon as possible or a supplement lateral fixation/self-locking cage should be used in high-risk patients. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Hao Li
- Department of Orthopedics Surgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Jiefang road 88, 310009, Hangzhou, People's Republic of China
| | - Zheng Kuan Xu
- Department of Orthopedics Surgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Jiefang road 88, 310009, Hangzhou, People's Republic of China
| | - Ning Zhang
- Department of Orthopedics Surgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Jiefang road 88, 310009, Hangzhou, People's Republic of China
| | - Fangcai Li
- Department of Orthopedics Surgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Jiefang road 88, 310009, Hangzhou, People's Republic of China.
| | - Qixin Chen
- Department of Orthopedics Surgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Jiefang road 88, 310009, Hangzhou, People's Republic of China
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