Prevalence and risk factors for cage subsidence after lumbar interbody fusion

Abstract Background Cage subsidence was previously reported as one of the most common complications following oblique lumbar interbody fusion (OLIF). We aimed to assess the impacts of CS on surgical results following OLIF, and determine its radiological characteristics and related risk factors. Methods Two hundred and forty-two patients underwent OLIF at L4-5 and with a minimum 12 months follow-up were reviewed. Patients were divided into three groups according to the extent disk height (DH) decrease during the follow-up: no CS (DH decrease ≤ 2 mm), mild CS (2mm < DH decrease ≤ 4 mm) and severe CS (DH decrease > 4mm). The clinical and radiological results were compared between groups to evaluate the radiological features, clinical effects and risk factors of CS. Results CS was identified in 79 (32.6%) patients, including 48 (19.8%) with mild CS and 31 (11.8%) with severe CS. CS mainly identified within 1 month postoperatively and did not progress after 3 months postoperatively, and more noted in the caudal endplate (44, 55.7%). In terms of clinical results, patients in the mild CS group were significantly worse than those in the no CS group, and patients in the severe CS group were significantly worse than those in the mild CS group. There was no significant difference in fusion rate between no CS (92.6%, 151/163) and mild CS (83.3%, 40/48) groups. However, significant lower fusion rate was observed in severe CS group (64.5%, 20/31) compared to no CS group. CS related risk factors included osteoporosis (OR = 5.976), DH overdistraction (OR = 1.175), flat disk space (OR = 3.309) and endplate injury (OR = 6.135). Conclusion CS following OLIF was an early postoperative complication. Higher magnitudes of CS were associated with worse clinical improvements and lower intervertebral fusion. Osteoporosis and endplate injury were significant risk factor for CS. Additionally, flat disk space and DH overdistraction were also correlated with the increased probability of CS.

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Risk Factors of Cage Subsidence after Posterior Lumbar Interbody Fusion

Journal of Korean Society of Spine Surgery ◽

10.4184/jkss.2016.23.2.100 ◽

2016 ◽

Vol 23 (2) ◽

pp. 100 ◽

Cited By ~ 3

Author(s):

Dong-Yeong Lee ◽

Soon-Taek Jeong ◽

Chang-Hwa Hong ◽

Young-Lac Choi ◽

Byeong-Hun Kang ◽

...

Keyword(s):

Risk Factors ◽

Interbody Fusion ◽

Posterior Lumbar Interbody Fusion ◽

Lumbar Interbody Fusion ◽

Cage Subsidence

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IN WHICH PATIENTS IS IT POSSIBLE TO PERFORM STANDALONE LATERAL LUMBAR INTERBODY FUSION WITHOUT CAGE SUBSIDENCE?

Coluna/Columna ◽

10.1590/s1808-185120161503162720 ◽

2016 ◽

Vol 15 (3) ◽

pp. 226-229 ◽

Cited By ~ 2

Author(s):

LUIS MARCHI ◽

LUIZ PIMENTA ◽

RODRIGO AMARAL ◽

FERNANDA FORTTI ◽

JOES NOGUEIRA-NETO ◽

...

Keyword(s):

Risk Factors ◽

Interbody Fusion ◽

Risk Scores ◽

Control Group ◽

Lumbar Interbody Fusion ◽

Lateral Lumbar Interbody Fusion ◽

Cage Subsidence ◽

And Gender ◽

Correlation Factors ◽

Control Study

ABSTRACT Objective: To identify the factors related to the non-occurrence of cage subsidence in standalone lateral lumbar interbody fusion procedures. Methods: Case-control study of single level standalone lateral lumbar interbody fusion (LLIF) including 86 cases. Patients without cage subsidence composed the control group (C), while those in the subsidence group (S) developed cage subsidence. Preoperative data were examined to create a risk score based on correlation factors with S group. The proven risk factors were part of an evaluation score. Results: Of the 86 cases included, 72 were in group C and 14 in group S. The following risk factors were more prevalent in group S compared to C group: spondylolisthesis (93% vs 18%; p<0.001); scoliosis (31% vs 12%; p=0.033); women (79% vs 38%; p=0.007); older patients (average 57.0 vs 68.4 years; p=0.001). These risk factors were used in a score (0-4) to evaluate the risk in each case. The patients with higher risk scores had greater subsidence (p<0.001). Scores ≥2 were predictive of subsidence with 92% sensitivity and 72% specificity. Conclusions: It was possible to correlate the degree of subsidence in standalone LLIF procedures using demographic (age and gender) and pathological (spondylolisthesis and scoliosis) data. With a score based on risk factors and considering any score <2, the probability of non-occurrence of subsidence following standalone LLIF (negative predictive value) was 98%.

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