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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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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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Lee SH, Son DW, Bae SH, Lee JS, Kim YH, Sung SK, Lee SW, Song GS. Mini-Open Intercostal Retroperitoneal Approach for Upper Lumbar Spine Lateral Interbody Fusion. Neurospine 2023; 20:553-563. [PMID: 37401073 PMCID: PMC10323358 DOI: 10.14245/ns.2244960.480] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 02/13/2023] [Accepted: 03/09/2023] [Indexed: 07/05/2023] Open
Abstract
OBJECTIVE Conventional oblique lumbar interbody fusion (OLIF) approach is possible from the L2/3 to L4/5 levels. However, obstruction of the lower ribs (10th-12th) makes it difficult to maintain disc parallel maneuvers or orthogonal maneuvers. To overcome these limitations, we proposed an intercostal retroperitoneal (ICRP) approach to access the upper lumbar spine. This method does not expose the parietal pleura or require rib resection and employs a small incision. METHODS We enrolled patients who underwent a lateral interbody procedure on the upper lumbar spine (L1/2/3). We compared the incidence of endplate injury between conventional OLIF and ICRP approaches. In addition, by measuring the rib line, the difference in endplate injury according to rib location and approach was analyzed. We also analyzed the previous period (2018-2021) and the year 2022, when the ICRP has been actively applied. RESULTS A total of 121 patients underwent lateral interbody fusion to the upper lumbar spine (OLIF approach, 99 patients; ICRP approach, 22 patients). Endplate injuries occurred in 34 of 99 (34.3%) and 2 of 22 patients (9.1%) during the conventional and ICRP approaches, respectively (p = 0.037; odds ratio, 5.23). When the rib line was located at the L2/3 disc or L3 body, the endplate injury rate was 52.6% (20 of 38) for the OLIF approach but 15.4% (2 of 13) for the ICRP approach. Since 2022, the proportion of OLIF including L1/2/3 levels has increased 2.9-fold. CONCLUSION The ICRP approach is effective in reducing the incidence of endplate injury in patients with a relatively lower rib line, without pleural exposure or rib resection.
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Affiliation(s)
- Su Hun Lee
- Department of Neurosurgery, Pusan National University Yangsan Hospital, Research Institute for Convergence of Biomedical Science and Technology, Yangsan, Korea
| | - Dong Wuk Son
- Department of Neurosurgery, Pusan National University Yangsan Hospital, Research Institute for Convergence of Biomedical Science and Technology, Yangsan, Korea
- Department of Neurosurgery, Pusan National University School of Medicine, Yangsan, Korea
| | - Sung Hyun Bae
- Department of Neurosurgery, Pusan National University Yangsan Hospital, Research Institute for Convergence of Biomedical Science and Technology, Yangsan, Korea
| | - Jun Seok Lee
- Department of Neurosurgery, Pusan National University Yangsan Hospital, Research Institute for Convergence of Biomedical Science and Technology, Yangsan, Korea
| | - Young Ha Kim
- Department of Neurosurgery, Pusan National University Yangsan Hospital, Research Institute for Convergence of Biomedical Science and Technology, Yangsan, Korea
| | - Soon Ki Sung
- Department of Neurosurgery, Pusan National University Yangsan Hospital, Research Institute for Convergence of Biomedical Science and Technology, Yangsan, Korea
- Department of Neurosurgery, Pusan National University School of Medicine, Yangsan, Korea
| | - Sang Weon Lee
- Department of Neurosurgery, Pusan National University Yangsan Hospital, Research Institute for Convergence of Biomedical Science and Technology, Yangsan, Korea
- Department of Neurosurgery, Pusan National University School of Medicine, Yangsan, Korea
| | - Geun Sung Song
- Department of Neurosurgery, Pusan National University Yangsan Hospital, Research Institute for Convergence of Biomedical Science and Technology, Yangsan, Korea
- Department of Neurosurgery, Pusan National University School of Medicine, Yangsan, Korea
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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] [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 ZB, Nie MD, Zhang NZ, Liu S, Yuan JB, Lin XM, Cheng CK, Shi ZC, Mao NF. Biomechanical evaluation of a short-rod technique for lumbar fixation surgery. Front Bioeng Biotechnol 2022; 10:959210. [PMID: 36032712 PMCID: PMC9403742 DOI: 10.3389/fbioe.2022.959210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 07/18/2022] [Indexed: 11/13/2022] Open
Abstract
Objective: The purpose of this study was to analyze the stability and instrument-related complications associated with fixation of the lumbar spine using the Short-Rod (SR) technique. Methods: Using finite element analysis, this study assessed the stability of a bilateral lumbar fixation system when inserting the pedicle screws at angles of 10°, 15°, and 20° to the endplate in the sagittal plane. Using the most stable construct with a screw angle, the model was then assessed with different rod lengths of 25, 30, 35, and 45 mm. The optimal screw inclination angle and rod length were incorporated into the SR model and compared against traditional parallel screw insertion (pedicle screws in parallel to the endplate, PPS) in terms of the stability and risk of instrument-related complications. The following parameters were evaluated using the validated L4–L5 lumbar finite element model: axial stiffness, range of motion (ROM), stress on the endplate and facet joint, von-Mises stress on the contact surface between the screw and rod (CSSR), and screw displacement. Results: The results showed that the SR model with a 15° screw inclination angle and 35 mm rod length was superior in terms of construct stability and risk of complications. Compared to the PPS model, the SR model had lower stiffness, lower ROM, less screw displacement, and lower stress on the facet cartilage, the CSSR, and screws. However, the SR model also suffered more stress on the endplate in flexion and lateral bending. Conclusion: The SR technique with a 15° screw inclination and 35 mm rod length offers good lumbar stability with a low risk of instrument-related complications.
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Affiliation(s)
- Ze-Bin Huang
- Department of Spine Surgery, First Affiliated Hospital of Naval Medical University, Shanghai, China
| | - Mao-Dan Nie
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Ning-Ze Zhang
- Key Laboratory of Biomechanics and Mechanobiology, Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Shu Liu
- Department of Spine Surgery, First Affiliated Hospital of Naval Medical University, Shanghai, China
| | - Jia-Bin Yuan
- Department of Spine Surgery, First Affiliated Hospital of Naval Medical University, Shanghai, China
| | - Xu-Miao Lin
- Department of Spine Surgery, First Affiliated Hospital of Naval Medical University, Shanghai, China
| | - Cheng-Kung Cheng
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
- *Correspondence: Cheng-Kung Cheng, ; Zhi-Cai Shi, ; Ning-Fang Mao,
| | - Zhi-Cai Shi
- Department of Spine Surgery, First Affiliated Hospital of Naval Medical University, Shanghai, China
- *Correspondence: Cheng-Kung Cheng, ; Zhi-Cai Shi, ; Ning-Fang Mao,
| | - Ning-Fang Mao
- Department of Spine Surgery, First Affiliated Hospital of Naval Medical University, Shanghai, China
- *Correspondence: Cheng-Kung Cheng, ; Zhi-Cai Shi, ; Ning-Fang Mao,
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