scholarly journals Factors Influencing Early Disc Height Loss Following Lateral Lumbar Interbody Fusion

2020 ◽  
Vol 14 (5) ◽  
pp. 601-607
Author(s):  
Arun-Kumar Kaliya-Perumal ◽  
Tamara Lee Ting Soh ◽  
Mark Tan ◽  
Jacob Yoong-Leong Oh
Keyword(s):  
Interbody Fusion ◽  
Disc Height ◽  
Height Loss ◽  
Lumbar Interbody Fusion ◽  
Lateral Lumbar Interbody Fusion ◽  
Factors Influencing ◽  
Cage Subsidence ◽  
Indirect Decompression ◽  
Height Increase

Study Design: Retrospective radiological analysis.Purpose: To analyze the factors influencing early disc height loss following lateral lumbar interbody fusion (LLIF).Overview of Literature: Postoperative disc height loss can occur naturally as a result of mechanical loading. This phenomenon is enabled by the yielding of the polyaxial screw heads and settling of the cage to the endplates. When coupled with cage subsidence, there can be significant reduction in the foraminal space which ultimately compromises the indirect decompression achieved by LLIF.Methods: Seventy-two cage levels in 37 patients aged 62±10.2 years who underwent single or multilevel LLIF for degenerative spinal conditions were selected. Their preoperative and postoperative follow-up radiographs were used to measure the anterior disc height (ADH), posterior disc height (PDH), mean disc height (MDH), disc space angle (DSA), and segmental angle. Correlations between the loss of disc height and several factors, including age, construct length, preoperative lordosis, postoperative lordosis, disc height, cage dimensions, and cage position, were analyzed.Results: We found that the lateral interbody cages significantly increased ADH, PDH, MDH, and DSA after surgery (<i>p</i> <0.0001). However, there was a loss of disc height over time. All postoperative disc height parameters, especially the amount of increase in MDH (<i>r</i> =0.413, <i>p</i> <0.0001) after surgery, showed a significant positive association with early disc height loss. The levels demonstrating a significant (≥25%) height loss were those that exhibited a substantial height increase (128.3%, 4.6±3.0 to 10.5±5.6 mm) postoperatively. However, the levels that showed less than 25% height loss were those that exhibited, on average, only a 57.4% height increase post-operatively.Conclusions: The greater the postoperative increase in disc height, the greater the disc height loss throughout early follow-up. Therefore, achieving an optimal disc height rather than overcorrection is an important surgical strategy to adopt when performing LLIF.

scholarly journals The Influence of Endplate Morphology on Cage Subsidence in Patients With Stand-Alone Oblique Lateral Lumbar Interbody Fusion (OLIF)

2021 ◽  
pp. 219256822199209
Author(s):  
Ziang Hu ◽  
Dengwei He ◽  
Jiawei Gao ◽  
Zhongyou Zeng ◽  
Chao Jiang ◽  
...  
Keyword(s):  
Interbody Fusion ◽  
Disc Height ◽  
Treatment Level ◽  
Lumbar Interbody Fusion ◽  
Lateral Lumbar Interbody Fusion ◽  
Cage Subsidence ◽  
Disability Questionnaire ◽  
First Time ◽  
The Relationship

Study Design: A retrospective study of prospectively collected radiographic and clinical data. Objective: This study aims to investigate the relationship between endplate morphology parameters and the incidence of cage subsidence in patients with mini-open single-level oblique lateral lumbar interbody fusion (OLIF). Methods: We included 119 inpatients who underwent OLIF from February 2015 to December 2017. A total of 119 patients with single treatment level of OLIF were included. Plain anteroposterior and lateral radiograph were taken preoperatively, postoperatively, and during follow-up. The correlation between disc height, endplate concave angle/depth, cage position and cage subsidence were investigated. Functional rating index (Visual Analogue Scale for pain, and Roland Morris Disability Questionnaire) were employed to assess clinical outcomes. Results: Cage subsidence was more commonly seen at the superior endplates (42/119, 35.29%) than at the inferior endplates (6/119, 5.04%) (p < 0.01). More importantly, cage subsidence was significantly less in patients with superior endplates that were without concave angle (3/20, 15%) than with concave angle (37/99, 37.37%) (p < 0.05). Cage subsidence correlated negatively with preoperative anterior disc height (r = −0.21, p < 0.05), but positively with disc distraction rate (r = 0.27, p < 0.01). Lastly, the distance of cage to the anterior edges of the vertebral body showed a positive correlation (r = 0.26, p < 0.01). Conclusions: This study for the first time demonstrated that endplate morphology correlates with cage subsidence after OLIF. Since relatively flat endplates with smaller concave angle significantly diminish the incidence of subsidence, the morphology of cage surface should be taken into consideration when designing the next generation of cage. In addition, precise measurement of the disc height to avoid over-distraction, and more anteriorly placement of the cage is suggested to reduce subsidence.

scholarly journals Short-term outcomes of lateral lumbar interbody fusion without decompression for the treatment of symptomatic degenerative spondylolisthesis at L4–5

2018 ◽  
Vol 44 (1) ◽  
pp. E6 ◽  
Author(s):  
Peter G. Campbell ◽  
Pierce D. Nunley ◽  
David Cavanaugh ◽  
Eubulus Kerr ◽  
Philip Andrew Utter ◽  
...  
Keyword(s):  
Interbody Fusion ◽  
Degenerative Spondylolisthesis ◽  
Sensory Loss ◽  
Motor Deficit ◽  
Lumbar Interbody Fusion ◽  
Lateral Lumbar Interbody Fusion ◽  
Estimated Blood Loss ◽  
Indirect Decompression ◽  
The Mean

OBJECTIVERecently, authors have called into question the utility and complication index of the lateral lumbar interbody fusion procedure at the L4–5 level. Furthermore, the need for direct decompression has also been debated. Here, the authors report the clinical and radiographic outcomes of transpsoas lumbar interbody fusion, relying only on indirect decompression to treat patients with neurogenic claudication secondary to Grade 1 and 2 spondylolisthesis at the L4–5 level.METHODSThe authors conducted a retrospective evaluation of 18 consecutive patients with Grade 1 or 2 spondylolisthesis from a prospectively maintained database. All patients underwent a transpsoas approach, followed by posterior percutaneous instrumentation without decompression. The Oswestry Disability Index (ODI) and SF-12 were administered during the clinical evaluations. Radiographic evaluation was also performed. The mean follow-up was 6.2 months.RESULTSFifteen patients with Grade 1 and 3 patients with Grade 2 spondylolisthesis were identified and underwent fusion at a total of 20 levels. The mean operative time was 165 minutes for the combined anterior and posterior phases of the operation. The estimated blood loss was 113 ml. The most common cage width in the anteroposterior dimension was 22 mm (78%). Anterior thigh dysesthesia was identified on detailed sensory evaluation in 6 of 18 patients (33%); all patients experienced resolution within 6 months postoperatively. No patient had lasting sensory loss or motor deficit. The average ODI score improved 26 points by the 6-month follow-up. At the 6-month follow-up, the SF-12 mean Physical and Mental Component Summary scores improved by 11.9% and 9.6%, respectively. No patient required additional decompression postoperatively.CONCLUSIONSThis study offers clinical results to establish lateral lumbar interbody fusion as an effective technique for the treatment of Grade 1 or 2 degenerative spondylolisthesis at L4–5. The use of this surgical approach provides a minimally invasive solution that offers excellent arthrodesis rates as well as favorable clinical and radiological outcomes, with low rates of postoperative complications. However, adhering to the techniques of transpsoas lateral surgery, such as minimal table break, an initial look-and-see approach to the psoas, clear identification of the plexus, minimal cranial caudal expansion of the retractor, mobilization of any traversing sensory nerves, and total psoas dilation times less than 20 minutes, ensures the lowest possible complication profile for both visceral and neural injuries even in the narrow safe zones when accessing the L4–5 disc space in patients with degenerative spondylolisthesis.

scholarly journals Effects of intradiscal vacuum phenomenon on surgical outcome of lateral interbody fusion for degenerative lumbar disease

2017 ◽  
Vol 26 (4) ◽  
pp. 419-425 ◽  
Author(s):  
Chun-Po Yen ◽  
Joshua M. Beckman ◽  
Andrew C. Vivas ◽  
Konrad Bach ◽  
Juan S. Uribe
Keyword(s):  
Interbody Fusion ◽  
Pedicle Screws ◽  
Retrospective Chart Review ◽  
Disc Height ◽  
Lumbar Interbody Fusion ◽  
Vacuum Phenomenon ◽  
Lateral Lumbar Interbody Fusion ◽  
Cage Subsidence ◽  
Degenerative Lumbar Disease ◽  
The Mean

OBJECTIVE The authors investigated whether the presence of intradiscal vacuum phenomenon (IVP) results in greater correction of disc height and restoration of segmental lordosis (SL). METHODS A retrospective chart review was performed on every patient at the University of South Florida's Department of Neurosurgery treated with lateral lumbar interbody fusion between 2011 and 2015. From these charts, preoperative plain radiographs and CT images were reviewed for the presence of IVP. Preoperative and postoperative posterior disc height (PDH), anterior disc height (ADH), and SL were measured at disc levels with IVP and compared with those at disc levels without IVP using the t-test. Linear regression was used to evaluate the factors that predict changes in PDH, ADH, and SL. RESULTS One hundred forty patients with 247 disc levels between L-1 and L-5 were treated with lateral lumbar interbody fusion. Among all disc levels treated, the mean PDH increased from 3.69 to 6.66 mm (p = 0.011), the mean ADH increased from 5.45 to 11.53 mm (p < 0.001), and the mean SL increased from 9.59° to 14.55° (p < 0.001). Significantly increased PDH was associated with the presence of IVP, addition of pedicle screws, and lack of cage subsidence; significantly increased ADH was associated with the presence of IVP, anterior longitudinal ligament (ALL) release, addition of pedicle screws, and lack of subsidence; and significantly increased SL was associated with the presence of IVP and ALL release. CONCLUSIONS IVP in patients with degenerative spinal disease remains grossly underreported. The data from the present study suggest that the presence of IVP results in increased restoration of disc height and SL.

scholarly journals Safety of a novel modular cage for transforaminal lumbar interbody fusion − clinical cohort study in 20 patients with degenerative disc disease

SICOT-J ◽  
2018 ◽  
Vol 4 ◽  
pp. 24
Author(s):  
Mohamed Elmekaty ◽  
Emad ElMehy ◽  
Peter Försth ◽  
Anna MacDowall ◽  
Ahmed El Elemi ◽  
...  
Keyword(s):  
Lumbar Lordosis ◽  
Interbody Fusion ◽  
Transforaminal Lumbar Interbody Fusion ◽  
Disc Height ◽  
Lumbar Interbody Fusion ◽  
Screw Loosening ◽  
Non Union ◽  
Cage Subsidence ◽  
One Year

Introduction: Transforaminal lumbar interbody fusion (TLIF) is used to reconstruct disc height and reduce degenerative deformity in spinal fusion. Patients with osteoporosis are at high risk of TLIF cage subsidence; possibly due to the relatively small footprint compared to anterior interbody devices. Recently, modular TLIF cage with an integral rail and slot system was developed to reduce cage subsidence and allow early rehabilitation. Objective: To study the safety of a modular TLIF device in patients with degenerative disc disorders (DDD) with regard to surgical complications, non-union, and subsidence. Methods: Patients with DDD treated with a modular TLIF cage (Polyetheretherketone (PEEK), VTI interfuse S) were analysed retrospectively with one-year follow-up. Lumbar sagittal parameters were collected preoperatively, postoperatively and at one year follow-up. Cage subsidence, fusion rate, screw loosening and proportion of endplate coverage were assessed in computed tomography scan. Results: 20 patients (age 66 ± 10 years, 65% female, BMI 28 ± 5 kg/m2) with a total of 37 fusion levels were included. 15 patients had degenerative spondylosis and 5 patients had degenerative scoliosis. The cages covered >60% of the vertebral body diameters. Lumbar lordosis angle and segmental disc angle increased from 45.2 ± 14.5 and 7.3 ± 3.6 to 52.7 ± 9.1 and 10.5 ± 3.5 (p =  0.029 and 0.0002) postoperatively for each parameter respectively without loss of correction at one year follow up. One case of deep postoperative infection occurred (5%). No cage subsidence occurred. No non-union or screw loosening occurred. Conclusions: The modular TLIF cage was safe with regard to subsidence and union-rate. It restored and maintained lumbar lordosis angle, segmental disc angle and disc height, which can be attributed to the large footprint of this modular cage.

scholarly journals The radiological outcome in lumbar interbody fusion among rheumatoid arthritis patients: a 20-year retrospective study

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Kuan-Kai Tung ◽  
Yun-Che Wu ◽  
Kun-Hui Chen ◽  
Chien-Chou Pan ◽  
Wen-Xian Lu ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Interbody Fusion ◽  
Fusion Rate ◽  
Substantial Improvement ◽  
Lumbar Interbody Fusion ◽  
Subsidence Rate ◽  
Radiographic Outcomes ◽  
Significant Difference ◽  
Cage Subsidence

Abstract Background Clinical outcomes amongst Rheumatoid Arthritis (RA) patients have shown satisfactory results being reported after lumbar surgery. The increased adoption of the interbody fusion technique has been due to a high fusion rate and less invasive procedures. However, the radiographic outcome for RA patients after receiving interbody fusion has scarcely been addressed in the available literature. Methods Patients receiving interbody fusion including ALIF, OLIF, and TLIF were examined for implant cage motion and fusion status at two-year follow-up. Parameters for the index correction level including ADH, PDH, WI, SL, FW, and FH were measured and compared at pre-OP, post-OP, and two-year follow-up. Results We enrolled 64 RA patients at 104 levels (mean 64.0 years old, 85.9% female) received lumbar interbody fusion. There were substantial improvement in ADH, PDH, WI, SL, FW, and FH after surgery, with both ADH and PDH having significantly dropped at two-year follow up. The OLIF group suffered from a higher subsidence rate with no significant difference in fusion rate when compared to TLIF. The fusion rate and subsidence rate for all RA patients was 90.4 and 28.8%, respectively. Conclusions We revealed the radiographic outcomes of lumbar interbody fusions towards symptomatic lumbar disease in RA patients with good fusion outcome despite the relative high subsidence rate amongst the OLIF group. Those responsible for intra-operative endplate management should be more cautious to avoid post-OP cage subsidence.

scholarly journals Evaluation of cage subsidence in standalone lateral lumbar interbody fusion: Novel 3D-printed titanium versus polyetheretherketone (peek) cage

2021 ◽  
Vol 1 ◽  
pp. 100153
Author(s):  
Dominik Adl Amini ◽  
Ichiro Okano ◽  
Lisa Oezel ◽  
Jiaqi Zhu ◽  
Erika Chiapparelli ◽  
...  
Keyword(s):  
Interbody Fusion ◽  
Lumbar Interbody Fusion ◽  
Peek Cage ◽  
Lateral Lumbar Interbody Fusion ◽  
Cage Subsidence ◽  
3D Printed

scholarly journals Feasibility of Endoscopic Transforaminal Lumbar Interbody Fusion through the Posterior Paraspinal Approach: Technical Note and Preliminary Result

2020 ◽  
Author(s):  
Hyeun-Sung Kim ◽  
Harshavardhan Dilip Raorane ◽  
Pang Hung Wu ◽  
Dong Hwa Heo ◽  
Yeon Jin Yi ◽  
...  
Keyword(s):  
Lumbar Lordosis ◽  
Interbody Fusion ◽  
Plain Radiograph ◽  
Transforaminal Lumbar Interbody Fusion ◽  
Disc Height ◽  
Graft Material ◽  
Lumbar Interbody Fusion ◽  
Paraspinal Approach ◽  
Segmental Lordosis

Abstract Background: The implement of endoscopic spinal surgery into degenerative spinal disease has minimized the requirement of fusion procedures. However, it is still necessary to develop endoscopic spine surgery in certain patients requiring fusion such as instability. We performed a full-endoscopic transforaminal lumbar interbody fusion(eTLIF) through a conventional paraspinal approach. The feasibility of procedure and early outcome were evaluated.Materials and Methods: eighteen consecutive patients with degenerative lumbar disease underwent eTLIF through a conventional paraspinal approach. Their clinical outcomes were evaluated with visual analog scale(VAS) leg pain score, Oswestry Disability Index(ODI) and the MacNab's criteria; radiological outcome measured with segmental lordosis, global lumbar lordosis, disc height on plain radiograph and percentage of potential fusion mass on CT scan at pre-operative, post-operative and final follow up period. intra operative and post-operative complications noted.Results: Mean age was 63. 71 years and Mean follow-up periods was 7.78 months. According to the level, L2-3 (1 case), L3-4 (4 cases), L4-5 (13 cases) and L5-S1 (2 cases). In the X-ray result, mean segmental lordosis angle(SLA) improved in pre-operative/post-operative/follow-up period 9.87±2.74 degree/ 11.79±3.74 degree/ 10.56±3.69 degree (p > 0.01); mean lumbar lordosis angle(LLA) improved 37.1±7.04 degree/ 39.2±7.13 degree/ 35.7±7.25 degree(p > 0.01). Mean preoperative disc height(DH) improved from 8.97±1.49 mm/ 12.34±1.39 mm/ 11.44±1.98 mm (p < 0.01). In the CT result, Average percentage of fusion mass was 42.61%. VAS was improved significantly, 7.67 / 3.39 / 2.5 and ODI was improved significantly, 74.9 / 34.56 / 27.76 by each preoperative / postoperative / final follow-up. In the clinical result, excellent was 5 cases and good was 13 cases. Conclusion: According to the results of this study, eTLIF was competent enough to perform as open TLIF. and good results were obtained in the form of endplate preservation, disc height restoration, minimal blood loss and post-operative pain with early mobilization. In addition, the fusion volume including the cage and the bone graft material occupies 40% to 50% of disc space is expected to give sufficient fusion by using 3D printed cages which gives the high fusion rate. In conclusion, eTLIF is considered to be a viable surgical procedure.

Reasons for revision following stand-alone anterior lumbar interbody fusion and lateral lumbar interbody fusion

2021 ◽  
pp. 1-7
Author(s):  
Austin Q. Nguyen ◽  
Jackson P. Harvey ◽  
Krishn Khanna ◽  
Bryce A. Basques ◽  
Garrett K. Harada ◽  
...  
Keyword(s):  
Interbody Fusion ◽  
Anterior Lumbar Interbody Fusion ◽  
Preoperative Imaging ◽  
Lumbar Interbody Fusion ◽  
Adjacent Level ◽  
Posterior Decompression ◽  
Less Invasive ◽  
Lateral Lumbar Interbody Fusion ◽  
Reoperation Rates

OBJECTIVE Anterior lumbar interbody fusion (ALIF) and lateral lumbar interbody fusion (LLIF) are alternative and less invasive techniques to stabilize the spine and indirectly decompress the neural elements compared with open posterior approaches. While reoperation rates have been described for open posterior lumbar surgery, there are sparse data on reoperation rates following these less invasive procedures without direct posterior decompression. This study aimed to evaluate the overall rate, cause, and timing of reoperation procedures following anterior or lateral lumbar interbody fusions without direct posterior decompression. METHODS This was a retrospective cohort study of all consecutive patients indicated for an ALIF or LLIF for lumbar spine at a single academic institution. Patients who underwent concomitant posterior fusion or direct decompression surgeries were excluded. Rates, causes, and timing of reoperations were analyzed. Patients who underwent a revision decompression were matched with patients who did not require a reoperation, and preoperative imaging characteristics were analyzed to assess for risk factors for the reoperation. RESULTS The study cohort consisted of 529 patients with an average follow-up of 2.37 years; 40.3% (213/529) and 67.3% (356/529) of patients had a minimum of 2 years and 1 year of follow-up, respectively. The total revision rate was 5.7% (30/529), with same-level revision in 3.8% (20/529) and adjacent-level revision in 1.9% (10/529) of patients. Same-level revision patients had significantly shorter time to revision (7.14 months) than adjacent-level revision patients (31.91 months) (p < 0.0001). Fifty percent of same-level revisions were for a posterior decompression. After further analysis of decompression revisions, an increased preoperative canal area was significantly associated with a lower risk of further decompression revision compared to the control group (p = 0.015; OR 0.977, 95% CI 0.959–0.995). CONCLUSIONS There was a low reoperation rate after anterior or lateral lumbar interbody fusions without direct posterior decompression. The majority of same-level reoperations were due to a need for further decompression. Smaller preoperative canal diameters were associated with the need for revision decompression.

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