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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 2024; 14:1889-1898. [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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Jang HD, Lee JC, Choi SW, Hong CH, Suh YS, Shin BJ. A novel surgical approach using the "lateral corridor" for minimally invasive oblique lumbar interbody fusion at L5-S1: a clinical series and technical note. 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; 33:2611-2620. [PMID: 38819738 DOI: 10.1007/s00586-024-08217-6] [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: 08/28/2023] [Revised: 02/23/2024] [Accepted: 03/06/2024] [Indexed: 06/01/2024]
Abstract
PURPOSE The minimally invasive oblique lumbar interbody fusion (MI-OLIF) L5-S1 was introduced to overcome the limitations of conventional fusion techniques, however, MI-OLIF is not possible using the standard method due to vascular structures in some cases. We aimed to introduce the "lateral corridor" and report the details of the surgical technique with a clinical case series. METHODS We utilized the lateral access route of the left common iliac vein and named it the "lateral corridor", to distinguish the technique from the standard technique (central corridor). The type and frequency of branch vessels that required additional manipulations were reviewed, and the frequency of intraoperative vascular injury was investigated. RESULTS Among the 107 patients who underwent MI-OLIF L5-S1, 26 patients (24.3%) who received the "lateral corridor" technique were included. Branch vessel ligation was required in 42.3% of the patients. The types of branch vessels that required ligation were seven cases (26.9%) of the iliolumbar vein (ILV) and six cases (23.1%) of ascending lumbar vein (ALV). The ILV and ALV were ligated in two cases. None of the patients developed intraoperative vascular injuries. CONCLUSION We introduced the "lateral corridor" as an alternative approach for MI-OLIF L5-S1, implemented it in 24.3% of the patient cohort, and reported favorable outcomes devoid of vascular complications. The "lateral corridor" necessitated ligation of the ILV or ALV in 42.3% of cases. The "lateral corridor" approach appears to be a promising surgical technique, offering feasibility even in instances where the vascular anatomy precludes the employment of the conventional approach.
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Affiliation(s)
- Hae-Dong Jang
- Department of Orthopaedic Surgery, Soonchunhyang University Bucheon Hospital, 170 Jomaru-ro, Bucheon-si, Gyeonggi-do, 14584, Republic of Korea
| | - Jae Chul Lee
- Department of Orthopaedic Surgery, Soonchunhyang University Seoul Hospital, 59 Daesagwan-ro, Yongsan-gu, Seoul, 04401, Republic of Korea
| | - Sung-Woo Choi
- Department of Orthopaedic Surgery, Soonchunhyang University Seoul Hospital, 59 Daesagwan-ro, Yongsan-gu, Seoul, 04401, Republic of Korea
| | - Chang-Hwa Hong
- Department of Orthopaedic Surgery, Soonchunhyang University Cheonan Hospital, 31 Soonchunhyang 6-gil, Dongnam-gu, Cheonan-si, Chungcheongnam-do, 31151, Republic of Korea
| | - You-Sung Suh
- Department of Orthopaedic Surgery, Soonchunhyang University Seoul Hospital, 59 Daesagwan-ro, Yongsan-gu, Seoul, 04401, Republic of Korea
| | - Byung-Joon Shin
- Department of Orthopaedic Surgery, Soonchunhyang University Seoul Hospital, 59 Daesagwan-ro, Yongsan-gu, Seoul, 04401, Republic of Korea.
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Diebo BG, Balmaceno-Criss M, Daher M, Daniels AH. Bilateral psoas release for long standing hip-spine syndrome: surgical technique and case report. NORTH AMERICAN SPINE SOCIETY JOURNAL 2023; 15:100247. [PMID: 37636341 PMCID: PMC10458283 DOI: 10.1016/j.xnsj.2023.100247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 07/13/2023] [Accepted: 07/23/2023] [Indexed: 08/29/2023]
Abstract
Background Severe positive sagittal malalignment can potentially lead to shortening and contracture of the psoas and joint capsule in a flexed spinopelvic position. The utilization of bilateral psoas release to supplement sagittal spinal deformity correction in the same hospitalization was not reported in the literature. Case presentation A 66-year-old patient presented with a 5-year history of severe global spinal deformity (sagittal vertical axis 220 mm, 60° spinopelvic mismatch) that did not improve on supine radiographs, and a modified Thomas test with more than 30° flexion contracture of bilateral hips. A 3-stage operation utilizing posterior spinal column osteotomies, anterior lumbar interbody fusion, and bilateral psoas releases was performed. Outcome Her postoperative alignment significantly improved and she was pleased with her new posture and the ability to stand up straight. Conclusions This report is the first to demonstrate safe and substantial correction of severe spinal deformities associated with bilateral hip flexion contracture in 1 hospitalization.
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Affiliation(s)
- Bassel G. Diebo
- Department of Orthopaedic Surgery, Brown University, Providence, RI, United States
- Spine surgery division, University Orthopedics Inc, 1 Kettle Point Ave, East Providence, RI, 02914, United States
| | - Mariah Balmaceno-Criss
- Department of Orthopaedic Surgery, Brown University, Providence, RI, United States
- Spine surgery division, University Orthopedics Inc, 1 Kettle Point Ave, East Providence, RI, 02914, United States
| | - Mohammad Daher
- Department of Orthopaedic Surgery, Brown University, Providence, RI, United States
- Spine surgery division, University Orthopedics Inc, 1 Kettle Point Ave, East Providence, RI, 02914, United States
| | - Alan H. Daniels
- Department of Orthopaedic Surgery, Brown University, Providence, RI, United States
- Spine surgery division, University Orthopedics Inc, 1 Kettle Point Ave, East Providence, RI, 02914, United States
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Ouyang P, Tan Q, He X, Zhao B. Computational comparison of anterior lumbar interbody fusion and oblique lumbar interbody fusion with various supplementary fixation systems: a finite element analysis. J Orthop Surg Res 2023; 18:4. [PMID: 36593501 PMCID: PMC9806898 DOI: 10.1186/s13018-022-03480-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 12/28/2022] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND AND OBJECTIVE Anterior lumbar interbody fusion (ALIF) and oblique lumbar interbody fusion (OLIF) have shown a great surgical potential, while it has always been controversial which surgical approach and which type of fixation system should be selected. This study investigated the biomechanical response of ALIF and OLIF with various supplementary fixation systems using the finite element method. MATERIALS AND METHODS Lumbar L4-L5 ALIF and OLIF models stabilized by different supplementary fixation systems (stand-alone cage, integrated stand-alone cage, anterior plate, and bilateral pedicle screw) were developed to assess the segmental range of motion (ROM), endplate stress (EPS), and screw-bone interface stress (SBIS). EXPERIMENTAL RESULTS ALIF showed lower ROM and EPS than OLIF in all motion planes and less SBIS in the most of motion planes compared with OLIF when the anterior plate or pedicle screw was used. ALIF induced higher ROM, while lower EPS and SBIS than OLIF in the majority of motion planes when integrated stand-alone cage was utilized. Using a stand-alone cage in ALIF and OLIF led to cage migration. Integrated stand-alone cage prevented the cage migration, whereas caused significantly larger ROM, EPS, and SBIS than other fixation systems except for the rotation plane. In the most of motion planes, the pedicle screw had the lowest ROM, EPS, and SBIS. The anterior plate induced a slightly larger ROM, EPS, and SBIS than the pedicle screw, while the differences were not significant. CONCLUSION ALIF exhibited a better performance in postoperative segmental stability, endplate stress, and screw-bone interface stress than OLIF when the anterior plate or the pedicle screw was used. The pedicle screw could provide the greatest postoperative segmental stability, less cage subsidence incidence, and lower risk of fixation system loosening in ALIF and OLIF. The anterior plate could also contribute to the stability required and fewer complications, while not as effectively as the pedicle screw. Extreme caution should be regarded when the stand-alone cage is used due to the risk of cage migration. The integrated stand-alone cage may be an alternative method; however, further optimization is needed to reduce complications and improve postoperative segmental stability.
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Affiliation(s)
- Pengrong Ouyang
- grid.452672.00000 0004 1757 5804Department of Orthopedics, Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi Province China
| | - Qinghua Tan
- grid.452672.00000 0004 1757 5804Department of Orthopedics, Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi Province China
| | - Xijing He
- grid.452672.00000 0004 1757 5804Department of Orthopedics, Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi Province China
| | - Bo Zhao
- grid.452672.00000 0004 1757 5804Department of Orthopedics, Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi Province China
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Farber SH, Sagar S, Godzik J, Zhou JJ, Walker CT, Khajavi K, Turner JD, Uribe JS. Radiographic comparison of lordotic and hyperlordotic implants in L5-S1 anterior lumbar interbody fusion. J Neurosurg Spine 2022; 36:775-783. [PMID: 34798612 DOI: 10.3171/2021.7.spine202221] [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: 12/28/2020] [Accepted: 07/14/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Anterior lumbar interbody fusion (ALIF) used at the lumbosacral junction provides arthrodesis for several indications. The anterior approach allows restoration of lumbar lordosis, an important goal of surgery. With hyperlordotic ALIF implants, several options may be employed to obtain the desired amount of lordosis. In this study, the authors compared the degree of radiographic lordosis achieved with lordotic and hyperlordotic ALIF implants at the L5-S1 segment. METHODS All patients undergoing L5-S1 ALIF from 2 institutions over a 4-year interval were included. Patients < 18 years of age or those with any posterior decompression or osteotomy were excluded. ALIF implants in the lordotic group had 8° or 12° of inherent lordosis, whereas implants in the hyperlordotic group had 20° or 30° of lordosis. Upright standing radiographs were used to determine all radiographic parameters, including lumbar lordosis, segmental lordosis, disc space lordosis, and disc space height. Separate analyses were performed for patients who underwent single-segment fixation at L5-S1 and for the overall cohort. RESULTS A total of 204 patients were included (hyperlordotic group, 93 [45.6%]; lordotic group, 111 [54.4%]). Single-segment ALIF at L5-S1 was performed in 74 patients (hyperlordotic group, 27 [36.5%]; lordotic group, 47 [63.5%]). The overall mean ± SD age was 61.9 ± 12.3 years; 58.3% of patients (n = 119) were women. The mean number of total segments fused was 3.2 ± 2.6. Overall, 66.7% (n = 136) of patients had supine surgery and 33.3% (n = 68) had lateral surgery. Supine positioning was significantly more common in the hyperlordotic group than in the lordotic group (83.9% [78/93] vs 52.3% [58/111], p < 0.001). After adjusting for differences in surgical positioning, the change in lumbar lordosis was significantly greater for hyperlordotic versus lordotic implants (3.6° ± 7.5° vs 0.4° ± 7.5°, p = 0.048) in patients with single-level fusion. For patients receiving hyperlordotic versus lordotic implants, changes were also significantly greater for segmental lordosis (12.4° ± 7.5° vs 8.4° ± 4.9°, p = 0.03) and disc space lordosis (15.3° ± 5.4° vs 9.3° ± 5.8°, p < 0.001) after single-level fusion at L5-S1. The change in disc space height was similar for these 2 groups (p = 0.23). CONCLUSIONS Hyperlordotic implants provided a greater degree of overall lumbar lordosis restoration as well as L5-S1 segmental and disc space lordosis restoration than lordotic implants. The change in disc space height was similar. Differences in lateral and supine positioning did not affect these parameters.
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Affiliation(s)
- S Harrison Farber
- 1Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona; and
| | - Soumya Sagar
- 1Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona; and
| | - Jakub Godzik
- 1Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona; and
| | - James J Zhou
- 1Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona; and
| | - Corey T Walker
- 1Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona; and
| | - Kaveh Khajavi
- 2Southeastern Neurosurgical Specialists, Georgia Spine and Neurosurgery Center, Atlanta, Georgia
| | - Jay D Turner
- 1Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona; and
| | - Juan S Uribe
- 1Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona; and
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Kamalapathy PN, Vatani J, Raso J, Hassanzadeh H, Li X. How old is too old?: Matched analysis of geriatric patients undergoing anterior lumbar interbody fusion. Clin Neurol Neurosurg 2021; 212:107090. [PMID: 34922291 DOI: 10.1016/j.clineuro.2021.107090] [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: 10/28/2021] [Revised: 12/10/2021] [Accepted: 12/12/2021] [Indexed: 11/28/2022]
Abstract
STUDY DESIGN Retrospective Review INTRODUCTION/OBJECTIVE: The aim of this study is to utilize a national database to identify how age affects patient outcomes following anterior lumbar interbody fusion (ALIF). There are no established age guidelines for the geriatric population within the spine specialty, which makes patient selection challenging. Furthermore, there are conflicting studies for the risks of performing spine surgeries in the elderly. METHODS A retrospective review of the Mariner Claims Database was conducted on patients who underwent a single level ALIF (CPT 22558) between 2010 and 2018. Patients were separated into three groups by age: 50-64, 65-74, and 75-84 and matched with respect to gender, smoking, and comorbidity burden. Multivariable logistic regression was used to determine the independent effect of outpatient surgery on the postoperative outcomes after adjusting for demographic factors and pertinent comorbidities. Statistical significance was set at p < 0.05. RESULTS The study identified 8459 matched patients (3350 50-64; 3350 65-74; and 1759 75-84). Compared with patients aged 50-64, patients aged 65-74 and 75-84 had significantly increased risks of pneumonia (65-74: OR 1.53, 95% CI 1.06-2.24, p = 0.025; 75-84: OR 1.62, 95% CI 1.07-2.42, p = 0.022), sepsis (65-74: OR 2.20, 95% CI 1.36-3.76, p = 0.002; 75-84: OR 2.42, 95% CI 1.43-4.13, p = 0.001), and major complications (65-74: OR 1.35, 95% CI 1.05-1.74, p = 0.021; 75-84: OR 1.48, 95% CI 1.11-1.95, p = 0.006) (Table 2). There were no significant differences between patients aged 65-74 and 75-84 for risks of postoperative pneumonia, sepsis, and major complications (p > 0.05). There were no differences between any groups in terms of long-term outcomes such as pseudoarthrosis, implant related complications, or reoperation (p > 0.05) (Table 3). DISCUSSION/CONCLUSION The study showed that those older than 65 had a significant increase in risk of pneumonia, sepsis, and major complications following ALIF. In the two cohorts above the age of 65 (65-74 and 75-84) there was no significant differences in postoperative outcomes. LEVEL OF EVIDENCE 3.
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Affiliation(s)
- Pramod N Kamalapathy
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA, USA
| | - Jasmine Vatani
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA, USA
| | - Jon Raso
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA, USA
| | - Hamid Hassanzadeh
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA, USA
| | - Xudong Li
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA, USA.
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Tung KK, Hsu FW, Ou HC, Chen KH, Pan CC, Lu WX, Chin NC, Shih CM, Wu YC, Lee CH. The Morphological Changes in Adjacent Segments Amongst Patients Receiving Anterior and Oblique Lumbar Interbody Fusion: A Retrospective Study. J Clin Med 2021; 10:jcm10235533. [PMID: 34884235 PMCID: PMC8658535 DOI: 10.3390/jcm10235533] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Revised: 11/22/2021] [Accepted: 11/26/2021] [Indexed: 12/30/2022] Open
Abstract
Adjacent segment disease (ASD) is troublesome condition that has proved to be highly related to spinal malalignment after spinal surgery. Hence, we aimed to evaluate the morphological changes after anterior lumbar interbody fusion (ALIF) and oblique LIF (OLIF) to establish the differences between the two surgical methods in terms of possible ASD avoidance. Fifty patients, half of whom received ALIF while the other half received OLIF, were analyzed with image studies and functional outcomes during the pre-operative and post-operative periods, and 2 years after surgery. Image measurements obtained included spinal-pelvic parameters, index lordosis (IL), segmental lordosis (SL), anterior disc height (ADH), posterior disc height (PDH) and adjacent segment disc angle (ASDA). The ADH and PDH in the adjacent segment decreased in the two groups while OLIF showed greater decrease without radiological ASD noted at 2-year follow-up. Both groups showed an increase in IL after surgery while ALIF showed greater improvement. No statistical difference was identified in functional outcomes between LIFs. We suggest that both ALIF and OLIF can restore adequate lordosis and prevent ASD after surgery. However, it should be noted that patient selection remains crucial when making any decision involving which of the two methods to use.
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Affiliation(s)
- Kuan-Kai Tung
- Department of Orthopedics, Taichung Veterans General Hospital, Taichung 40705, Taiwan; (K.-K.T.); (K.-H.C.); (C.-C.P.); (N.-C.C.); (C.-M.S.); (Y.-C.W.)
| | - Fang-Wei Hsu
- Department of Orthopedics, Kuang Tien General Hospital, Taichung 433, Taiwan;
| | - Hsien-Che Ou
- Department of Medicine Education, Taipei Veterans General Hospital, Taipei 112201, Taiwan;
| | - Kun-Hui Chen
- Department of Orthopedics, Taichung Veterans General Hospital, Taichung 40705, Taiwan; (K.-K.T.); (K.-H.C.); (C.-C.P.); (N.-C.C.); (C.-M.S.); (Y.-C.W.)
- Department of Biomedical Engineering, Hung Kuang University, Taichung 433304, Taiwan
- Department of Computer Science and Information Engineering, Providence University, Taichung 43301, Taiwan
- Department of Nursing, Jen-Teh Junior College of Medicine, Nursing and Management, Miaoli 35664, Taiwan
| | - Chien-Chou Pan
- Department of Orthopedics, Taichung Veterans General Hospital, Taichung 40705, Taiwan; (K.-K.T.); (K.-H.C.); (C.-C.P.); (N.-C.C.); (C.-M.S.); (Y.-C.W.)
- Department of Rehabilitation Science, Jen-Teh Junior College of Medicine, Nursing and Management, Miaoli 35664, Taiwan
| | - Wen-Xian Lu
- Department of Orthopedics, Feng Yuan Hospital Ministry of Health and Welfare, Taichung 420, Taiwan;
| | - Ning-Chien Chin
- Department of Orthopedics, Taichung Veterans General Hospital, Taichung 40705, Taiwan; (K.-K.T.); (K.-H.C.); (C.-C.P.); (N.-C.C.); (C.-M.S.); (Y.-C.W.)
| | - Cheng-Min Shih
- Department of Orthopedics, Taichung Veterans General Hospital, Taichung 40705, Taiwan; (K.-K.T.); (K.-H.C.); (C.-C.P.); (N.-C.C.); (C.-M.S.); (Y.-C.W.)
- Department of Physical Therapy, Hung Kuang University, Taichung 433304, Taiwan
- PhD Degree Program of Biomedical Science and Engineering, College of Biological Science and Technology, National Yang Ming Chiao Tung University, Hsinchu 300093, Taiwan
| | - Yun-Che Wu
- Department of Orthopedics, Taichung Veterans General Hospital, Taichung 40705, Taiwan; (K.-K.T.); (K.-H.C.); (C.-C.P.); (N.-C.C.); (C.-M.S.); (Y.-C.W.)
| | - Cheng-Hung Lee
- Department of Orthopedics, Taichung Veterans General Hospital, Taichung 40705, Taiwan; (K.-K.T.); (K.-H.C.); (C.-C.P.); (N.-C.C.); (C.-M.S.); (Y.-C.W.)
- College of Medicine, National Chung Hsing University, Taichung 40227, Taiwan
- Department of Food Science and Technology, Hung Kuang University, Taichung 433304, Taiwan
- Correspondence: ; Tel.: +886-4-23592525
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Inoue G, Saito W, Miyagi M, Imura T, Shirasawa E, Ikeda S, Mimura Y, Kuroda A, Yokozeki Y, Inoue S, Akazawa T, Nakazawa T, Uchida K, Takaso M. Prevalence and location of endplate fracture and subsidence after oblique lumbar interbody fusion for adult spinal deformity. BMC Musculoskelet Disord 2021; 22:880. [PMID: 34649548 PMCID: PMC8518321 DOI: 10.1186/s12891-021-04769-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 10/04/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Recently, Oblique lumbar interbody fusion (OLIF) is commonly indicated to correct the sagittal and coronal alignment in adult spinal deformity (ASD). Endplate fracture during surgery is a major complication of OLIF, but the detailed location of fracture in vertebral endplate in ASD has not yet been determined. We sought to determine the incidence and location of endplate fracture and subsidence of the OLIF cage in ASD surgery, and its association with fusion status and alignment. METHODS We analyzed 75 levels in 27 patients were analyzed using multiplanar CT to detect the endplate fracture immediately after surgery and subsidence at 1 year postoperatively. The prevalence was compared between anterior and posterior, approach and non-approach sides, and concave and convex side. Their association with fusion status, local and global alignment, and complication was also investigated. RESULTS Endplate fracture was observed in 64 levels (85.3%) in all 27 patients, and the incidence was significantly higher in the posterior area compared with the anterior area (85.3 vs. 68.0%, p=0.02) of affected vertebra in the sagittal plane. In the coronal plane, there was no significant difference in incidence between left (approach) and right (non-approach) sides (77.3 and 81.3%, respectively), or concave and convex sides (69.4 and 79.6%) of wedged vertebra. By contrast, cage subsidence at 1 year postoperatively was noted in 14/75 levels (18.7%), but was not associated with endplate fracture. Fusion status, local and global alignment, and complications were not associated with endplate fracture or subsidence. CONCLUSION Endplate fracture during OLIF procedure in ASD cases is barely avoidable, possibly induced by the corrective maneuver with ideal rod counter and cantilever force, but is less associated with subsequent cage subsidence, fusion status, and sustainment of corrected alignment in long fusion surgery performed even for elderly patients.
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Affiliation(s)
- Gen Inoue
- Department of Orthopaedic Surgery, Kitasato University School of Medicine, 1-15-1, Kitazato, Minami-ku, Sagamihara, Kanagawa, 252-0374, Japan.
| | - Wataru Saito
- Department of Orthopaedic Surgery, Kitasato University School of Medicine, 1-15-1, Kitazato, Minami-ku, Sagamihara, Kanagawa, 252-0374, Japan.,Department of Orthopaedic Surgery, Kitasato University Medical Center, Kitamoto, Saitama, Japan
| | - Masayuki Miyagi
- Department of Orthopaedic Surgery, Kitasato University School of Medicine, 1-15-1, Kitazato, Minami-ku, Sagamihara, Kanagawa, 252-0374, Japan
| | - Takayuki Imura
- Department of Orthopaedic Surgery, Kitasato University School of Medicine, 1-15-1, Kitazato, Minami-ku, Sagamihara, Kanagawa, 252-0374, Japan
| | - Eiki Shirasawa
- Department of Orthopaedic Surgery, Kitasato University School of Medicine, 1-15-1, Kitazato, Minami-ku, Sagamihara, Kanagawa, 252-0374, Japan
| | - Shinsuke Ikeda
- Department of Orthopaedic Surgery, Kitasato University School of Medicine, 1-15-1, Kitazato, Minami-ku, Sagamihara, Kanagawa, 252-0374, Japan
| | - Yusuke Mimura
- Department of Orthopaedic Surgery, Kitasato University School of Medicine, 1-15-1, Kitazato, Minami-ku, Sagamihara, Kanagawa, 252-0374, Japan
| | - Akiyoshi Kuroda
- Department of Orthopaedic Surgery, Kitasato University School of Medicine, 1-15-1, Kitazato, Minami-ku, Sagamihara, Kanagawa, 252-0374, Japan
| | - Yuji Yokozeki
- Department of Orthopaedic Surgery, Kitasato University School of Medicine, 1-15-1, Kitazato, Minami-ku, Sagamihara, Kanagawa, 252-0374, Japan
| | - Sho Inoue
- Department of Orthopaedic Surgery, Kitasato University School of Medicine, 1-15-1, Kitazato, Minami-ku, Sagamihara, Kanagawa, 252-0374, Japan
| | - Tsutomu Akazawa
- Department of Orthopaedic Surgery, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Toshiyuki Nakazawa
- Department of Orthopaedic Surgery, Kitasato University School of Medicine, 1-15-1, Kitazato, Minami-ku, Sagamihara, Kanagawa, 252-0374, Japan
| | - Kentaro Uchida
- Department of Orthopaedic Surgery, Kitasato University School of Medicine, 1-15-1, Kitazato, Minami-ku, Sagamihara, Kanagawa, 252-0374, Japan.,Shonan University of Medical Sciences Research Institute, Chigasaki, Kanagawa, Japan
| | - Masashi Takaso
- Department of Orthopaedic Surgery, Kitasato University School of Medicine, 1-15-1, Kitazato, Minami-ku, Sagamihara, Kanagawa, 252-0374, Japan
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Pham MH, Hassan O, Diaz-Aguilar LD, Lehman RA. Complications Associated With Oblique Lumbar Interbody Fusion at L5-S1: A Systematic Review of the Literature. NEUROSURGERY OPEN 2021. [DOI: 10.1093/neuopn/okab018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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