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Aguirre AO, Soliman MAR, Kuo CC, Kassay A, Parmar G, Kruk MD, Quiceno E, Khan A, Lim J, Hess RM, Mullin JP, Pollina J. Defining cage subsidence in anterior, oblique, and lateral lumbar spine fusion approaches: a systematic review of the literature. Neurosurg Rev 2024; 47:332. [PMID: 39009745 DOI: 10.1007/s10143-024-02551-5] [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: 01/05/2024] [Revised: 06/27/2024] [Accepted: 07/03/2024] [Indexed: 07/17/2024]
Abstract
One of the most common complications of lumbar fusions is cage subsidence, which leads to collapse of disc height and reappearance of the presenting symptomology. However, definitions of cage subsidence are inconsistent, leading to a variety of subsidence calculation methodologies and thresholds. To review previously published literature on cage subsidence in order to present the most common methods for calculating and defining subsidence in the anterior lumbar interbody fusion (ALIF), oblique lateral interbody fusion (OLIF), and lateral lumbar interbody fusion (LLIF) approaches. A search was completed in PubMed and Embase with inclusion criteria focused on identifying any study that provided descriptions of the method, imaging modality, or subsidence threshold used to calculate the presence of cage subsidence. A total of 69 articles were included in the final analysis, of which 18 (26.1%) reported on the ALIF approach, 22 (31.9%) on the OLIF approach, and 31 (44.9%) on the LLIF approach, 2 of which reported on more than one approach. ALIF articles most commonly calculated the loss of disc height over time with a subsidence threshold of > 2 mm. Most OLIF articles calculated the total amount of cage migration into the vertebral bodies, with a threshold of > 2 mm. LLIF was the only approach in which most articles applied the same method for calculation, namely, a grading scale for classifying the loss of disc height over time. We recommend future articles adhere to the most common methodologies presented here to ensure accuracy and generalizability in reporting cage subsidence.
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Affiliation(s)
- Alexander O Aguirre
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, 100 High Street, Suite B4, Buffalo, NY, 14203, USA
- Department of Neurosurgery, Buffalo General Medical Center, Kaleida Health, Buffalo, NY, USA
| | - Mohamed A R Soliman
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, 100 High Street, Suite B4, Buffalo, NY, 14203, USA
- Department of Neurosurgery, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Cathleen C Kuo
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
| | - Andrea Kassay
- Division of Neurosurgery, University of Toronto, Toronto, ON, Canada
| | - Gaganjot Parmar
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
| | - Marissa D Kruk
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
| | - Esteban Quiceno
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, 100 High Street, Suite B4, Buffalo, NY, 14203, USA
- Department of Neurosurgery, Buffalo General Medical Center, Kaleida Health, Buffalo, NY, USA
| | - Asham Khan
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, 100 High Street, Suite B4, Buffalo, NY, 14203, USA
- Department of Neurosurgery, Buffalo General Medical Center, Kaleida Health, Buffalo, NY, USA
| | - Jaims Lim
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, 100 High Street, Suite B4, Buffalo, NY, 14203, USA
- Department of Neurosurgery, Buffalo General Medical Center, Kaleida Health, Buffalo, NY, USA
| | - Ryan M Hess
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, 100 High Street, Suite B4, Buffalo, NY, 14203, USA
- Department of Neurosurgery, Buffalo General Medical Center, Kaleida Health, Buffalo, NY, USA
| | - Jeffrey P Mullin
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, 100 High Street, Suite B4, Buffalo, NY, 14203, USA
- Department of Neurosurgery, Buffalo General Medical Center, Kaleida Health, Buffalo, NY, USA
| | - John Pollina
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, 100 High Street, Suite B4, Buffalo, NY, 14203, USA.
- Department of Neurosurgery, Buffalo General Medical Center, Kaleida Health, Buffalo, NY, USA.
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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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Shen S, You X, Ren Y, Ye S. Risk Factors of Cage Subsidence Following Oblique Lumbar Interbody Fusion: A Meta-analysis and Systematic Review. World Neurosurg 2024; 183:180-186. [PMID: 38145652 DOI: 10.1016/j.wneu.2023.12.110] [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: 11/27/2023] [Accepted: 12/19/2023] [Indexed: 12/27/2023]
Abstract
OBJECTIVES The aim of this systematic review was to evaluate the risk factors for cage subsidence (CS) after oblique lumbar interbody fusion (OLIF). METHODS The cohort and case-control studies which reporting potential risk factors for CS following OLIF were searched in PubMed, Embase, and Web of Science from database inception to June 17, 2023. Two researchers independently screened the literature, extracted data, and evaluated the quality of the literature according to the Newcastle Ottawa Scale. RevMan5.3 software was used for Meta analysis. χ2 statistics and I2 statistics were used to evaluate heterogeneity, and the analysis results were represented by forest plots. RESULTS A total of 8 studies with 280 cases of CS from 832 patients who underwent OLIF met the inclusion criteria. Elderly patients over 60 years old (odds ratio [OR] 2.44, 95% CI 1.38-4.31, P = 0.002), osteoporosis (OR 4.18, 95% CI 2.30-7.61, P = 0.002), end plate injury (OR 5.72, 95% CI 2.32-14.11, P = 0.0002), and overdistraction of intervertebral space (OR 1.67, 95% CI 1.3 2-2.11, P < 0.0001) were potential risk factors, while Hounsfield units value of the vertebral body (OR 0.97, 95% CI 0.95-1.00, P = 0.02) is a protective factor. The number of operative segments did not increase the risk of CS. CONCLUSIONS Older age, osteoporosis, endplate injury, and overdistraction of the intervertebral space may increase the risk of CS after OLIF. Although the incidence rate of CS is low, implementing effective preventions is a priority for clinicians based on these risk factors.
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Affiliation(s)
- Shufeng Shen
- Department of Spinal Surgery, Yuyao People's Hospital, Zhejiang Province, China.
| | - Xinmao You
- Department of Spinal Surgery, Yuyao People's Hospital, Zhejiang Province, China
| | - Yingqing Ren
- Department of Spinal Surgery, Yuyao People's Hospital, Zhejiang Province, China
| | - Senqi Ye
- Department of Spinal Surgery, Yuyao People's Hospital, Zhejiang Province, China
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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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Pu X, Wang D, Gu S. Advances in Hounsfield units value for predicting cage subsidence on spinal interbody fusion surgery. 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 2023; 32:3149-3157. [PMID: 37306798 DOI: 10.1007/s00586-023-07805-2] [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: 01/26/2023] [Revised: 01/26/2023] [Accepted: 05/28/2023] [Indexed: 06/13/2023]
Abstract
PURPOSE A growing number of studies have demonstrated that Hounsfield units (HU) value can effectively assess bone quality and predict cage subsidence (CS) after spinal surgery. The purpose of this review is to provide an overview of the utility of the HU value for predicting CS after spinal surgery and to raise some of the unresolved questions in this field. METHODS We searched on PubMed, EMBASE, MEDLINE, and Cochrane Library for studies correlating HU value to CS. RESULTS Thirty-seven studies were included in this review. We found that HU value can predicted the risk of CS effectively after spinal surgery. Moreover, the HU value of the cancellous vertebral body and the cortical endplate were used for predicting CS, in comparison, the measurement method of HU value in the cancellous vertebral body was more standardized, but which region is more important to CS remains unknown. Different cutoff thresholds of HU value have been established in different surgical procedures for predicting CS. The HU value may be superior to dual-energy X-ray absorptiometry (DEXA) for CS prediction; however, the usage standard of HU value has not been well established. CONCLUSIONS The HU value shows great potential for predicting CS and constitutes an advantage over DEXA. However, general consensuses about how CS is defined and HU is measured, which part of HU value is more important, and the appropriate cutoff threshold of the HU value for osteoporosis and CS still require exploration.
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Affiliation(s)
- Xingxiao Pu
- Department of Orthopedic Spine Surgery, Yan'an Hospital Affiliated to Kunming Medical University, 245# Panlong, Renmingdonglu, Kunming, 650051, Yunnan, People's Republic of China
| | - Daxing Wang
- Department of Orthopedic Spine Surgery, Yan'an Hospital Affiliated to Kunming Medical University, 245# Panlong, Renmingdonglu, Kunming, 650051, Yunnan, People's Republic of China.
| | - Shao Gu
- Department of Orthopedic Spine Surgery, Yan'an Hospital Affiliated to Kunming Medical University, 245# Panlong, Renmingdonglu, Kunming, 650051, Yunnan, People's Republic of China.
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Chen KJ, Huang YC, Lin HH, Chou PH, Wang ST, Wang CY, Chang MC, Yao YC. The Impact of Cage and End plate-Related Factors on Cage Subsidence in Oblique Lateral Interbody Fusion. World Neurosurg 2023; 173:e629-e638. [PMID: 36871649 DOI: 10.1016/j.wneu.2023.02.118] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 02/23/2023] [Accepted: 02/24/2023] [Indexed: 03/06/2023]
Abstract
OBJECTIVES To identify cage and end plate factors of cage subsidence (CS) in patients who underwent oblique lateral interbody fusion (OLIF) and their association with patient-reported outcomes. METHODS Sixty-one patients (43 women and 18 men), with a total of 69 segments (138 end plates) which underwent OLIF at a single academic institution between November 2018 and November 2020, were included. All the end plates were separated into CS and nonsubsidence groups. Cage-related parameters (cage height, cage width, cage insertion level, and cage position) and end plate-related parameters (position of end plate, Hounsfield unit value of the vertebra, end plate concave angle [ECA], end plate injury, and angular mismatch measured with cage/end plate angle [C/EA]) were compared and analyzed using logistic regression to predict CS. Receiver operating characteristic curve analysis was used to determine the cutoff points of the parameters. RESULTS Postoperative CS was identified in 50 of the 138 end plates (36.2%). The CS group had significantly lower mean Hounsfield unit values of the vertebra, higher rate of end plate injury, lower ECA, and higher C/EA than the nonsubsidence group. ECA and C/EA were identified as independent risk factors for developing CS. The optimal cutoff points for ECA and C/EA were 176.9° and 5.4°, respectively. CONCLUSIONS An ECA greater than 176.9° and a cage/end plate angular mismatch greater than 5.4° were found to be independent risk factors of postoperative CS after the OLIF procedure. These findings aid in preoperative decision-making and intraoperative technical guidance.
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Affiliation(s)
- Kuan-Jung Chen
- Department of Orthopaedics, China Medical University Hsinchu Hospital, Hsinchu, Taiwan; Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Orthopaedics, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yen-Chun Huang
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Orthopaedics, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Hsi-Hsien Lin
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Orthopaedics, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Po-Hsin Chou
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Orthopaedics, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Shih-Tien Wang
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Orthopaedics, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chien-Yuan Wang
- Department of Orthopaedics, China Medical University Hsinchu Hospital, Hsinchu, Taiwan; Department of Orthopaedics, College of Medicine, China Medical University, Taichung, Taiwan
| | - Ming-Chau Chang
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Orthopaedics, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yu-Cheng Yao
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Orthopaedics, School of Medicine, National Yang Ming Chiao Tung University, Taipei, 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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Wu H, Shan Z, Zhang T, Liu J, Fan S, Zhao F, Cheung JPY. Small Preoperative Dural Sac Cross-Sectional Area and Anteriorly Placed Fusion Cages Are Risk Factors for Indirect Decompression Failure after Oblique Lateral Interbody Fusion. World Neurosurg 2022; 167:e1032-e1044. [PMID: 36067941 DOI: 10.1016/j.wneu.2022.08.134] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 08/28/2022] [Accepted: 08/29/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVE 1) To investigate if implant-related factors such as cage size and cage position are associated with radiologic improvement after indirect decompression with oblique lateral interbody fusion (OLIF). 2) To investigate the risk factors associated with indirect decompression failure (IDF) at the surgical levels after OLIF. METHODS From February 2015 to December 2019, 92 consecutive patients (188 levels) with lumbar spinal stenosis who underwent indirect decompression via OLIF with or without posterior instrumentation were studied retrospectively. Radiographic variables were measured preoperatively and postoperatively. The radiographic results were compared for cages with different heights and positions. IDF was defined as revision surgery within 6 months or persistent compressive symptoms 6 months after surgery. RESULTS Postoperative improvements were observed in all measured radiographic parameters except for segmental lordosis. Taller cages were associated with more shrinkage of the bulging disc and greater increase in dural sac diameter. Cages placed posteriorly showed larger postoperative subarticular diameters. Twelve patients (16 levels) had IDF. Multivariate logistic regression showed that after adjusting for age, sex, and body mass index, smaller preoperative dural sac cross-sectional area and anterior positioning of cages were both independent risk factors for IDF. CONCLUSIONS OLIF is an effective procedure for indirect decompression. To avoid reoperation for lumbar spinal stenosis, surgeons should aim to place the center of the cage at the posterior half of the lower endplate. Surgical levels with a preoperative dural sac cross-sectional area <44 mm2 may not be suitable for indirect decompression.
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Affiliation(s)
- Hao Wu
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong
| | - Zhi Shan
- Department of Orthopaedics, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Zhejiang, China
| | - Teng Zhang
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong
| | - Junhui Liu
- Department of Orthopaedics, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Zhejiang, China
| | - Shunwu Fan
- Department of Orthopaedics, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Zhejiang, China
| | - Fengdong Zhao
- Department of Orthopaedics, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Zhejiang, China
| | - Jason Pui Yin Cheung
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong.
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Lin GX, Chen CM, Jhang SW, Zhu MT, Lyu P, Hu BS. Characteristics and hotspots of the 50 most cited articles in the field of pre-psoas oblique lumbar interbody fusion. Front Surg 2022; 9:1004839. [PMID: 36311953 PMCID: PMC9597085 DOI: 10.3389/fsurg.2022.1004839] [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: 07/27/2022] [Accepted: 09/23/2022] [Indexed: 11/29/2022] Open
Abstract
PURPOSE In the past decade, the field of pre-psoas oblique lumbar interbody fusion (OLIF) has developed rapidly, and with it, the literature on OLIF has grown considerably. This study was designed to analyze the top 50 articles in terms of the number of citations through bibliometric research to demonstrate the research characteristics and hotspots of OLIF. METHOD Searching the Web of Science database yielded the 50 most cited publications in the OLIF field as of July 10, 2022. The publications were ranked according to the number of citations. The following sources were evaluated: the year of publications, the number of citations, authors, countries, institutions, journals, research topics, and keyword hotspots. RESULTS The most productive period was from 2017 to 2020, with 41 articles. The number of citations varied from 10 to 140, with an average of 35.52, and 1,776 citations were found. World Neurosurgery published the most articles (12), China produced the most articles (16), and the Catholic University of Korea produced the most studies (6). The corresponding author who produced the most articles was J.S. Kim (5), and the first author who produced the most publications was S. Orita (3). The main research topics were anatomical morphology, surgical techniques, indications, outcomes, and complications. The top 10 most cited keywords were "complications," "decompression," "spine," "surgery," "outcomes," "transpsoas approach," "spondylolisthesis," "anterior," "disease," and "injury." CONCLUSIONS Certain articles can be distinguished from others using citation analysis as an accurate representation of their impact due to their long-term effectiveness and peer recognition. With these publications, researchers are provided with research priorities and hotspots through influential literature in the field of OLIF.
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Affiliation(s)
- Guang-Xun Lin
- The School of Clinical Medicine, The Third Clinical Medical College, Fujian Medical University, China,Department of Orthopedics, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Chien-Min Chen
- Division of Neurosurgery, Department of Surgery, Changhua Christian Hospital, Changhua, Taiwan,Department of Leisure Industry Management, National Chin-Yi University of Technology, Taichung, Taiwan,College of Nursing and Health Sciences, Dayeh University, Taiwan
| | - Shang-Wun Jhang
- Division of Neurosurgery, Department of Surgery, Changhua Christian Hospital, Changhua, Taiwan
| | - Ming-Tao Zhu
- Department of Neurosurgery, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China,Correspondence: Bao-Shan Hu Ming-Tao Zhu Pengfei Lyu
| | - Pengfei Lyu
- Department of Breast Surgery, The First Affiliated Hospital of Hainan Medical University, Haikou, China,Correspondence: Bao-Shan Hu Ming-Tao Zhu Pengfei Lyu
| | - Bao-Shan Hu
- Department of Orthopedics, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China,Correspondence: Bao-Shan Hu Ming-Tao Zhu Pengfei Lyu
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10
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Wang Z, Mei J, Feng X, Deng C, Tian X, Lv J, Sun L. Low cervical vertebral CT value increased early subsidence of titanium mesh cage after anterior cervical corpectomy and fusion. J Orthop Surg Res 2022; 17:355. [PMID: 35842647 PMCID: PMC9287865 DOI: 10.1186/s13018-022-03239-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 07/01/2022] [Indexed: 11/10/2022] Open
Abstract
Study design This study was a retrospective review. Objective To study the predictive effect of Hounsfield units (HU) value in the cervical vertebral body derived from computed tomography (CT) on the early titanium mesh cage (TMC) subsidence after anterior cervical corpectomy and fusion (ACCF). Methods This retrospective study was conducted on patients who underwent ACCF at one institution between January 2014 and December 2018. We collected date included age, gender, body mass index (BMI), disease type, surgical segment, whether merge ACDF, HU value of the vertebral body and endplate, vertebral body height loss, cervical lordosis angle, and cervical sagittal alignment. VAS, JOA, and NDI were used to assess clinical efficacy. Univariate analysis was performed to screen the influencing factors of TMC subsidence, and then logistic regression was used to find out the independent risk factors. The ROC curve and area under curve (AUC) were used to analyze the HU value to predict the TMC subsidence. Results A total of 85 patients who accepted ACCF were included in this study, and early titanium mesh cage subsidence was demonstrated in 29 patients. The subsidence rate was 34.1%. The JOA, VAS, and NDI scores significantly improved in both groups after the operation. Between the subsidence and non-subsidence groups, there were significant differences in age, intervertebral distraction height, and HU value in both upper and lower vertebral body and endplate. The logistic regression analysis proved that the HU value of the lower vertebral body was an independent risk of TMC subsidence, the AUC was 0.866, and the most appropriate threshold of the HU value was 275 (sensitivity: 87.5%, specificity: 79.3%). Conclusion Preoperative cervical CT value is an independent correlative factor for early TMC subsidence after ACCF, and patients with a low CT value of the inferior vertebral body of the operative segment have a higher risk of TMC subsidence in the early postoperative period. Trial registration: This study is undergoing retrospective registration.
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Affiliation(s)
- Zhiqiang Wang
- Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan, 030032, China
| | - Jun Mei
- Department of orthopedics, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, 030032, China.,Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Xiaoning Feng
- Department of orthopedics, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, 030032, China.,Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Chen Deng
- Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan, 030032, China
| | - Xuefeng Tian
- Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan, 030032, China
| | - Junqiao Lv
- Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan, 030032, China
| | - Lin Sun
- Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan, 030032, China.
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11
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Kim H, Chang BS, Chang SY. Pearls and Pitfalls of Oblique Lateral Interbody Fusion: A Comprehensive Narrative Review. Neurospine 2022; 19:163-176. [PMID: 35378589 PMCID: PMC8987540 DOI: 10.14245/ns.2143236.618] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Accepted: 01/13/2022] [Indexed: 12/12/2022] Open
Abstract
Lumbar degenerative disease is a common problem in an aging society. Oblique lateral interbody fusion (OLIF) is a minimally invasive surgical (MIS) technique that utilizes a retroperitoneal antepsoas corridor to treat lumbar degenerative disease. OLIF has theoretical advantages over other lumbar fusion techniques, such as a lower risk of lumbar plexus injury than direct lateral interbody fusion (DLIF). Previous studies have reported favorable clinical and radiological outcomes of OLIF in various lumbar degenerative diseases. The use of OLIF is increasing, and evidence on OLIF is growing in the literature. The indications for OLIF are also expanding with the help of recent technical developments, including stereotactic navigation systems and robotics. In this review, we present current evidence on OLIF for the treatment of lumbar degenerative disease, focusing on the expansion of surgical indications and recent advancements in the OLIF procedure.
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Affiliation(s)
- Hyoungmin Kim
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul, Korea
| | - Bong-Soon Chang
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul, Korea
| | - Sam Yeol Chang
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul, Korea
- Corresponding Author Sam Yeol Chang https://orcid.org/0000-0003-4152-687X Department of Orthopedic Surgery, Seoul National University Hospital, 101 Daehakro, Jongno-gu, Seoul 03080, Korea
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