Effect of pedicle-screw rod fixation on oblique lumbar interbody fusion in patients with osteoporosis: a retrospective cohort study

Comparison of the Outcomes of Endoscopic Posterolateral Interbody Fusion and Lateral Interbody Fusion in the Treatment of Lumbar Degenerative Disease: A Systematic Review and Network Meta-Analysis

OBJECTIVE

Although endoscopic technologies have been increasingly applied in lumbar fusion surgery in recent years, the advantages and disadvantages of endoscopic posterolateral fusion compared with lateral fusion remain unclear. Six different single-level lumbar interbody fusion procedures were compared to determine whether indirect decompression fusion could achieve levels of efficacy and safety comparable to those of minimally invasive direct decompression fusion in the treatment of lumbar degenerative disease (LDD).

METHOD

A literature search was conducted in the PubMed, Embase, and Cochrane Library databases, and studies on the treatment of LDD published from 2004 to March 2024 were retrieved. The data of preset clinical outcome measures, including operation time, intraoperative estimated blood loss (EBL), length of hospital stay (LOS), complications, visual analog scale (VAS) score, and the Oswestry Disability Index (ODI), were extracted from the studies.

RESULTS

Thirty-five studies with 3467 patients were included in this review. Network meta-analysis revealed no significant differences in improvements in pain and disability or adverse events among the procedures, except for uniportal endoscopic lumbar interbody fusion (UELIF), which resulted in a lower degree of improvement in the ODI than oblique lateral interbody fusion (OLIF). Stand-alone lateral lumbar interbody fusion (SA-LLIF) exhibited the best performance in terms of indicators of early efficacy, such as surgical time and LOS. OLIF and SA-LLIF had higher fusion rates than did UELIF and minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF). MIS-TLIF resulted in greater EBL than did OLIF, SA-LLIF, and UELIF.

CONCLUSION

Minimally invasive lumbar interbody fusion achieves good therapeutic results in LDD patients regardless of the use of indirect or direct decompression, whereas SA-LLIF has better early efficacy.

Impact of Osteoporosis on Short-Term Surgical Outcomes in Lumbar Degenerative Disease Patients Undergoing Lateral Lumbar Interbody Fusion: A Retrospective Analysis

OBJECTIVE

This retrospective study assesses the influence of osteoporosis on the short-term clinical outcomes of lateral lumbar interbody fusion (LLIF) surgery in patients with lumbar degenerative diseases (LDDs), focusing on complications, pain intensity, and quality of life (QOL) improvements. The primary aim of this study is to investigate the impact of osteoporosis on the short-term clinical outcomes following LLIF surgery in LDD patients, with a particular focus on the incidence of cage subsidence (CS) and overall patient well-being postoperatively.

METHODS

A retrospective review was conducted on 73 patients who underwent LLIF for LDD. Patients were categorized into 2 groups based on osteoporosis status determined by dual-energy X-ray absorptiometry scans: those with osteoporosis (n = 20) and those without osteoporosis (n = 53). Data collection included demographics, surgical details, complications, magnetic resonance imaging analysis, pain intensity, and QOL (Japanese Orthopaedic Association Back Pain Evaluation Questionnaire).

RESULTS

The groups had no significant differences regarding operative time, estimated blood loss, and hospital stay duration. However, the incidence of CS was 40% in patients with osteoporosis, compared to 17% in nonosteoporotic patients. Despite this, significant improvements in spinal canal dimensions were observed in both groups. Both groups experienced significant reductions in pain intensity, with notable improvements in functional outcomes assessed by the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire, indicating the overall effectiveness of LLIF in enhancing patient well-being and functionality, irrespective of osteoporosis status.

CONCLUSIONS

Osteoporosis increases the risk of CS in LLIF surgery for LDD patients but does not affect short-term pain relief and QOL improvements.

Defining cage subsidence in anterior, oblique, and lateral lumbar spine fusion approaches: a systematic review of the literature

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.

Comparison of instrumented and stand-alone lateral lumbar interbody fusion for lumbar degenerative disease: a systematic review and meta-analysis

BACKGROUND

Both instrumented and stand-alone lateral lumbar interbody fusion (LLIF) have been widely used to treat lumbar degenerative disease. However, it remains controversial as whether posterior internal fixation is required when LLIF is performed. This meta-analysis aims to compare the radiographic and clinical results between instrumented and stand-alone LLIF.

METHODS

PubMed, EMBASE and Cochrane Collaboration Library up to March 2023 were searched for studies that compared instrumented and stand-alone LLIF in the treatment of lumbar degenerative disease. The following outcomes were extracted for comparison: interbody fusion rate, cage subsidence rate, reoperation rate, restoration of disc height, segmental lordosis, lumbar lordosis, visual analog scale (VAS) scores of low-back and leg pain and Oswestry Disability Index (ODI) scores.

RESULTS

13 studies involving 1063 patients were included. The pooled results showed that instrumented LLIF had higher fusion rate (OR 2.09; 95% CI 1.16-3.75; P = 0.01), lower cage subsidence (OR 0.50; 95% CI 0.37-0.68; P < 0.001) and reoperation rate (OR 0.28; 95% CI 0.10-0.79; P = 0.02), and more restoration of disc height (MD 0.85; 95% CI 0.18-1.53; P = 0.01) than stand-alone LLIF. The ODI and VAS scores were similar between instrumented and stand-alone LLIF at the last follow-up.

CONCLUSIONS

Based on this meta-analysis, instrumented LLIF is associated with higher rate of fusion, lower rate of cage subsidence and reoperation, and more restoration of disc height than stand-alone LLIF. For patients with high risk factors of cage subsidence, instrumented LLIF should be applied to reduce postoperative complications.

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

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.

Biomechanical evaluation of two-level oblique lumbar interbody fusion combined with posterior four-screw fixation：A finite element analysis

OBJECTIVE

By constructing the three-dimensional finite element model of two-level OLIF lumbar spine, the aim of this study was to demonstrate the feasibility and effectiveness of posterior four-screw fixation for treatment of two-level lumbar degenerative diseases from the perspective of biomechanics.

METHODS

An intact L3-S1 segment nonlinear lumbar finite element model (M0) was constructed from the CT scanning data of a healthy adult. After verification, two-level OLIF procedure were simulated, and three patterns of finite element analysis models were constructed: two-level stand-alone OLIF group (M1), two-level OLIF + four-screw fixation group (M2) and two-level OLIF + six-screw fixation group (M3). Range of motion, stress of the cage, and stress of fixation were evaluated in the different models.

RESULTS

Under various motion modes，the ROM of M2 and M3 were significantly lower than those of M1. The ROM reduction of M2 relative to M1 was much greater than that of M3 relative to M2. Moreover, the peak von Mises stresses of endplates in M2 were almost the same as those in M3. In terms of the maximum stresses of cages, M2 and M3 were essentially identical. Besides, the maximum stresses of posterior instrumentation in M2 and M3 were similar, which were mainly concentrated at the root of pedicle screws.

CONCLUSION

There were no significant differences between M2 and M3 from the biomechanical analysis. In two-level OLIF, posterior four-screw fixation can replace six-screw fixation, which reduces surgical trauma and decreases economic burden of patients, and will be a cost-effective alternative.