Risk factors for polyetheretherketone cage subsidence following minimally invasive transforaminal lumbar interbody fusion

<sec><title>Study Design</title>Retrospective review of prospective registry data.</sec><sec><title>Purpose</title>To determine 5-year clinical and radiological outcomes of single-level instrumented minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) in patients with neurogenic symptoms secondary to spondylolisthesis.</sec><sec><title>Overview of Literature</title>MIS-TLIF and open approaches have been shown to yield comparable outcomes. This is the first study to assess MIS-TLIF outcomes using the minimal clinically important difference (MCID) criterion.</sec><sec><title>Methods</title>The outcomes of 56 patients treated by a single surgeon, including the Oswestry disability index (ODI), neurogenic symptom score, short-form 36 questionnaire (SF-36), and visual analog scale (VAS) scores for back pain (BP), and leg pain (LP), were collected prospectively for up to 5 years postoperatively. Radiological outcomes included adjacent segment degeneration, fusion, cage subsidence, and screw loosening rates.</sec><sec><title>Results</title>Our patients were predominantly female (71.4%) and had a mean age of 53.7±11.3 years and mean body mass index of 25.7±3.7 kg/m2. The mean operative time, blood loss, time to ambulation, and hospitalization were 167±49 minutes, 126±107 mL, 1.2±0.4 days, and 2.8±1.1 days, respectively. The mean fluoroscopic time was 58.4±33 seconds, and the mean postoperative intravenous morphine dose was 8±2 mg. Regarding outcomes, postoperative scores improved relative to preoperative scores, and this was sustained across various time points for up to 5 years (<italic>p</italic><0.001). Improvements in ODI, SF-36, VAS-BP, and VAS-LP all met the MCID criterion. Notably, 5.4% of our patients developed clinically significant adjacent segment disease during follow-up, and 7 minor complications were reported.</sec><sec><title>Conclusions</title>Single-level instrumented MIS-TLIF is suitable for patients with neurogenic symptoms secondary to lumbar spondylolisthesis and is associated with an acceptable complication rate. Both clinical and radiological outcomes were sustained up to 5 years postoperatively, with many patients achieving an MCID.</sec>

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The identification of risk factors for increased postoperative pain following minimally invasive transforaminal lumbar interbody fusion

European Spine Journal ◽

10.1007/s00586-020-06344-4 ◽

2020 ◽

Vol 29 (6) ◽

pp. 1304-1310

Author(s):

Nathaniel W. Jenkins ◽

James M. Parrish ◽

Benjamin C. Mayo ◽

Nadia M. Hrynewycz ◽

Thomas S. Brundage ◽

...

Keyword(s):

Risk Factors ◽

Postoperative Pain ◽

Minimally Invasive ◽

Interbody Fusion ◽

Transforaminal Lumbar Interbody Fusion ◽

Lumbar Interbody Fusion

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Incidence of and risk factors for superior facet violation in minimally invasive versus open pedicle screw placement during transforaminal lumbar interbody fusion: a comparative analysis

Journal of Neurosurgery Spine ◽

10.3171/2013.1.spine12882 ◽

2013 ◽

Vol 18 (4) ◽

pp. 356-361 ◽

Cited By ~ 47

Author(s):

Darryl Lau ◽

Samuel W. Terman ◽

Rakesh Patel ◽

Frank La Marca ◽

Paul Park

Keyword(s):

Risk Factors ◽

Minimally Invasive ◽

Pedicle Screw ◽

Interbody Fusion ◽

Facet Joint ◽

Transforaminal Lumbar Interbody Fusion ◽

Screw Placement ◽

Lumbar Interbody Fusion ◽

Pedicle Screw Placement ◽

Percutaneous Pedicle Screw

Object A reported risk factor for adjacent-segment disease is injury to the superior facet joint from pedicle screw placement. Given that the facet joint is not typically visualized during percutaneous pedicle screw insertion, there is a concern for increased facet violation (FV) in minimally invasive fusion procedures. The purpose of this study was to analyze and compare the incidence of FV among patients undergoing minimally invasive transforaminal lumbar interbody fusion (MITLIF) and open transforaminal lumbar interbody fusion (TLIF). The impact of O-arm navigation compared with traditional fluoroscopy on FV in MITLIF is also assessed, as are risk factors for FV. Methods The authors identified a consecutive population of patients who underwent MITLIF with percutaneous pedicle screw placement, as well as a matched cohort of patients who underwent open TLIF. Postoperative CT imaging was assessed to determine intraarticular FV due to pedicle screw placement. Patients were stratified into minimally invasive and open TLIF groups. Within the MITLIF group, the authors performed a subanalysis of image guidance methods used in cases of FV. Two-tailed Student t-test, ANOVA, chi-square testing, and logistic regression were used for statistical analysis. Results A total of 282 patients were identified, with a total of 564 superior pedicle screw placements. The MITLIF group consisted of 142 patients with 284 screw insertions. The open TLIF group consisted of 140 patients with 280 screw insertions. Overall, 21 (7.4%) of 282 patients experienced FV. A total of 21 screws violated a facet joint for a screw-based FV rate of 3.7% (21 of 564 screws). There were no significant differences between the MITLIF and open TLIF groups in the percentage of patients with FV (6.3% vs 8.6%) and or the percentage of screws with FV (3.2% vs 4.3%) (p = 0.475 and p = 0.484, respectively). Further stratifying the MI group into O-arm navigation and fluoroscopic guidance subgroups, the patient-based rates of FV were 10.8% (4 of 37 patients) and 4.8% (5 of 105 patients), respectively, and the screw-based rates of FV were 5.4% (4 of 74 screws) and 2.4% (5 of 210 screws), respectively. There was no significant difference between the subgroups with respect to patient-based or screw-based FV rates (p = 0.375 and p = 0.442, respectively). The O-arm group had a significantly higher body mass index (BMI) (p = 0.021). BMI greater than 29.9 was independently associated with higher FV (OR 2.36, 95% CI 1.65–8.53, p = 0.039). Conclusions The findings suggest that minimally invasive pedicle screw placement is not associated with higher rates of FV. Overall violation rates were similar in MITLIF and open TLIF. Higher BMI, however, was a risk factor for increased FV. The use of O-arm fluoroscopy with computer-assisted guidance did not significantly decrease the rate of FV.

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Risk Factors for Medical and Surgical Complications After Single-Level Minimally Invasive Transforaminal Lumbar Interbody Fusion

The International Journal of Spine Surgery ◽

10.14444/7018 ◽

2020 ◽

Vol 14 (2) ◽

pp. 125-132 ◽

Cited By ~ 1

Author(s):

ANKUR S. NARAIN ◽

JAMES M. PARRISH ◽

NATHANIEL W. JENKINS ◽

BRITTANY E. HAWS ◽

BENJAMIN KHECHEN ◽

...

Keyword(s):

Risk Factors ◽

Minimally Invasive ◽

Surgical Complications ◽

Interbody Fusion ◽

Transforaminal Lumbar Interbody Fusion ◽

Lumbar Interbody Fusion ◽

Single Level

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Outcome of Ti/PEEK Versus PEEK Cages in Minimally Invasive Transforaminal Lumbar Interbody Fusion

Global Spine Journal ◽

10.1177/21925682211000323 ◽

2021 ◽

pp. 219256822110003

Author(s):

Yu-Cheng Yao ◽

Po-Hsin Chou ◽

Hsi-Hsien Lin ◽

Shih-Tien Wang ◽

Ming-Chau Chang

Keyword(s):

Minimally Invasive ◽

Interbody Fusion ◽

Transforaminal Lumbar Interbody Fusion ◽

Fusion Rate ◽

Lumbar Interbody Fusion ◽

Peek Cage ◽

Retrospective Case ◽

Peek Composite ◽

Cage Subsidence

Study Design: Retrospective case-control study. Objectives: This study aims to present the clinical and radiographical outcomes of the titanium-polyetheretherketone (Ti/PEEK) composite cage compared to those of the standard PEEK cage in patients receiving minimally invasive transforaminal lumbar interbody fusion (MI-TLIF). Methods: Patients receiving 1 level MI-TLIF between October 2015 and October 2017 were included with a minimum of 2-year follow-up. The patients were segregated into 2 groups; Ti/PEEK group and PEEK group. Each patient was propensity-matched using preoperative age, sex, and body mass index. Early fusion rate was evaluated by computed tomography at postoperative 6 months. Clinical outcomes were assessed using the visual analog scale (VAS) and Oswestry Disability Index (ODI) scores. Results: After matching, there were 27 patients included in each group. The demographics, diagnosis, and surgical details were not significantly different between the 2 groups. The 6-month rate was 88.9% in Ti/PEEK group. The fusion rate and cage subsidence rate had no difference between the 2 groups. The complication rate in the Ti/PEEK group was comparable to that in the PEEK group. There was no difference in VAS and ODI scores during a 2-year follow-up period. Conclusions: The use of Ti/PEEK composite cage was as safe and effective as the use of PEEK cage in MI-TLIF. The 6-month fusion rate was 88.9%. Our finding revealed comparable clinical results for surgeons using Ti/PEEK composite cages in MI-TLIF compared to those using the PEEK cage.

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Evaluations of minimally invasive transforaminal lumbar interbody fusion performed with rhBMP-2

10.21203/rs.2.12544/v1 ◽

2019 ◽

Author(s):

Bin Lv ◽

Yuting Hou ◽

Xiang Jin ◽

Dan Luo ◽

Lei Wang ◽

...

Keyword(s):

Minimally Invasive ◽

Clinical Data ◽

Interbody Fusion ◽

Transforaminal Lumbar Interbody Fusion ◽

Bone Morphogenetic Protein 2 ◽

Lumbar Interbody Fusion ◽

Significant Difference ◽

Patient Reported ◽

Cage Subsidence

Abstract Background: The combination of minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) and recombinant human bone morphogenetic protein 2 (rhBMP-2) is widely used for its advantage of rapid recovery and improved bone fusion. However, no previous study has reported the synergistic effect of MIS-TLIF with rhBMP-2 in patients with degenerative lumbar disease (DLD). Objective: To investigate the radiographic and patient-reported outcomes (PROs) in patients with DLD who underwent MIS-TLIF with and without a low dose of rhBMP-2. Methods: We retrospectively reviewed 48 patients treated with MIS-TLIF from 2013 to 2016. The patients were classified into the rhBMP-2 group (n = 25) and non-rhBMP-2 group (n = 23). Fusion-related parameters were measured before and after the operation. Clinical data included the numeric rating scale (NRS) score, Japanese Orthopedic Association (JOA) scores, and the MOS 36-item short form health survey (SF-36) score, which were documented to evaluate the effect of surgery. Results: In the 48 patients who underwent MIS-TLIF, the operated disc was predominantly at the L4/5 and L5/S1 levels. ADH, MDH, and PDH increased significantly in both groups after surgery (P < 0.05). FH improved in the rhBMP-2 group, but not in the non-rhBMP-2 group. There was no obvious improvement in SA in both groups. Furthermore, the SL showed a significant difference in both groups and a significant improvement over the baseline. The LL showed significant improvement in the two groups at the early follow-up (P < 0.05), but the improvement did not persist. Cage subsidence had no significant effect on different subsidence grades. In addition, no differences in cage subsidence were observed in different types of modic change (MC), except for MC 0 in both groups. There was no difference in PROs even though all clinical outcomes improved significantly during the postoperative follow-up period in both groups. Conclusion: MIS-TLIF with the low doses of rhBMP-2 resulted in an improvement in radiographic and clinical results, but not a longer-lasting restoration for radiographic outcomes. Cage subsidence is not associated with the MC. Further, our clinical data demonstrated no difference between both groups.

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Risk Factors Associated With Failure to Reach Minimal Clinically Important Difference in Patient-reported Outcomes Following Minimally Invasive Transforaminal Lumbar Interbody Fusion for Spondylolisthesis

Clinical Spine Surgery ◽

10.1097/bsd.0000000000000543 ◽

2018 ◽

Vol 31 (1) ◽

pp. E92-E97 ◽

Cited By ~ 8

Author(s):

Fady Y. Hijji ◽

Ankur S. Narain ◽

Daniel D. Bohl ◽

Kelly H. Yom ◽

Krishna T. Kudaravalli ◽

...

Keyword(s):

Risk Factors ◽

Minimally Invasive ◽

Patient Reported Outcomes ◽

Interbody Fusion ◽

Minimal Clinically Important Difference ◽

Transforaminal Lumbar Interbody Fusion ◽

Lumbar Interbody Fusion ◽

Factors Associated ◽

Clinically Important Difference ◽

Patient Reported

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Minimally Invasive Transforaminal Lumbar Interbody Fusion With Intraoperative Fluoroscopy for Disc Space Preparation: Analysis of Fusion Rate and Clinical Results

Operative Neurosurgery ◽

10.1093/ons/opaa178 ◽

2020 ◽

Vol 19 (5) ◽

pp. 557-566

Author(s):

Guang-Xun Lin ◽

Sagar Sharma ◽

Gang Rui ◽

Myung-Soo Song ◽

Jin-Sung Kim

Keyword(s):

Minimally Invasive ◽

Clinical Outcomes ◽

Interbody Fusion ◽

Transforaminal Lumbar Interbody Fusion ◽

Fusion Rate ◽

Lateral View ◽

Lumbar Interbody Fusion ◽

Disc Space ◽

Intraoperative Fluoroscopy ◽

Cage Subsidence

Abstract BACKGROUND Meticulous disc space preparation is an important step toward ensuring arthrodesis in the interbody fusion procedure. Although minimally invasive techniques are becoming increasingly advanced in lumbar interbody fusion, concerns exist regarding adequate discectomy and sufficient endplate preparation from a transforaminal lumbar approach. OBJECTIVE To describe the radiographic and clinical outcomes of single-level minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) using the intraoperative fluoroscopy-guided method for disc space preparation. METHODS This is a retrospective study of 25 patients operated between June 2016 and Dec 2017. The radiographic outcomes included the intraoperative percentage of disc space preparation, fusion, and subsidence. Percentage of disc space preparation was calculated through intraoperative fluoroscopic imaging. Clinical outcomes included visual analog scale (VAS), Oswestry Disability Index (ODI), and satisfaction rate. RESULTS Mean age of patients was 62.9 yr. The mean follow-up period was 22 mo. Mean extents of disc space preparation were 61.5% in the anteroposterior view and 80.3% in the lateral view. Fusion rates were 86% and 92% at 6 and 12-mo postoperatively, respectively. All patients showed clinical improvement according to VAS and ODI. CONCLUSION MI-TLIF with intraoperative fluoroscopy-guided disc space preparation is shown to lead to potentially improved fusion rate. It is a safe and effective surgical method for degenerative lumbar disease. Additionally, in cases of cage subsidence caused by the endplate violation during disc space preparation, thorough sufficient bone grafting of the defect region avoids pseudoarthrosis.

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