Early Postoperative Loss of Disc Height Following Transforaminal and Lateral Lumbar Interbody Fusion: A Radiographic Analysis

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.

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

Global Spine Journal ◽

10.1177/2192568221992098 ◽

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.

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Clinical and radiographic analysis of unilateral versus bilateral instrumented one-level lateral lumbar interbody fusion

Scientific Reports ◽

10.1038/s41598-020-59706-9 ◽

2020 ◽

Vol 10 (1) ◽

Author(s):

Masayoshi Fukushima ◽

Yasushi Oshima ◽

Yohei Yuzawa ◽

Sakae Tanaka ◽

Hirohiko Inanami

Keyword(s):

Interbody Fusion ◽

Radiographic Analysis ◽

Lumbar Interbody Fusion ◽

Lateral Lumbar Interbody Fusion

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Clinical and radiographic analysis of expandable versus static lateral lumbar interbody fusion devices with two-year follow-up

Journal of Spine Surgery ◽

10.21037/jss.2018.03.1 ◽

2018 ◽

Vol 4 (1) ◽

pp. 62-71

Author(s):

Richard F. Frisch ◽

Ingrid Y. Luna ◽

Daina M. Brooks ◽

Gita Joshua ◽

Joseph R. O’Brien

Keyword(s):

Interbody Fusion ◽

Radiographic Analysis ◽

Lumbar Interbody Fusion ◽

Lateral Lumbar Interbody Fusion

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Factors Influencing Early Disc Height Loss Following Lateral Lumbar Interbody Fusion

Asian Spine Journal ◽

10.31616/asj.2019.0332 ◽

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 (p <0.0001). However, there was a loss of disc height over time. All postoperative disc height parameters, especially the amount of increase in MDH (r =0.413, p <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.

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Clinical and radiographic analysis of expandable versus static lateral lumbar interbody fusion devices with two-year follow-up

Journal of Spine Surgery ◽

10.21037/jss.2018.03.16 ◽

2018 ◽

Vol 4 (1) ◽

pp. 62-71 ◽

Cited By ~ 3

Author(s):

Richard F. Frisch ◽

Ingrid Y. Luna ◽

Daina M. Brooks ◽

Gita Joshua ◽

Joseph R. O’Brien

Keyword(s):

Interbody Fusion ◽

Radiographic Analysis ◽

Lumbar Interbody Fusion ◽

Lateral Lumbar Interbody Fusion

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Lateral lumbar interbody fusion in revision surgery for restenosis after posterior decompression

Neurosurgical FOCUS ◽

10.3171/2020.6.focus20361 ◽

2020 ◽

Vol 49 (3) ◽

pp. E11 ◽

Cited By ~ 1

Author(s):

Yoshifumi Kudo ◽

Ichiro Okano ◽

Tomoaki Toyone ◽

Akira Matsuoka ◽

Hiroshi Maruyama ◽

...

Keyword(s):

Revision Surgery ◽

Spinal Canal ◽

Interbody Fusion ◽

Decompression Surgery ◽

Complication Rates ◽

Lumbar Interbody Fusion ◽

Posterior Decompression ◽

Lateral Lumbar Interbody Fusion ◽

Significant Difference ◽

Dural Tears

OBJECTIVEThe purpose of this study was to compare the clinical results of revision interbody fusion surgery between lateral lumbar interbody fusion (LLIF) and posterior lumbar interbody fusion (PLIF) or transforaminal lumbar interbody fusion (TLIF) with propensity score (PS) adjustments and to investigate the efficacy of indirect decompression with LLIF in previously decompressed segments on the basis of radiological assessment.METHODSA retrospective study of patients who underwent revision surgery for recurrence of neurological symptoms after posterior decompression surgery was performed. Postoperative complications and operative factors were evaluated and compared between LLIF and PLIF/TLIF. Moreover, postoperative improvement in cross-sectional areas (CSAs) in the spinal canal and intervertebral foramen was evaluated in LLIF cases.RESULTSA total of 56 patients (21 and 35 cases of LLIF and PLIF/TLIF, respectively) were included. In the univariate analysis, the LLIF group had significantly more endplate injuries (p = 0.03) and neurological deficits (p = 0.042), whereas the PLIF/TLIF group demonstrated significantly more dural tears (p < 0.001), surgical site infections (SSIs) (p = 0.02), and estimated blood loss (EBL) (p < 0.001). After PS adjustments, the LLIF group still showed significantly more endplate injuries (p = 0.03), and the PLIF/TLIF group demonstrated significantly more dural tears (p < 0.001), EBL (p < 0.001), and operating time (p = 0.04). The PLIF/TLIF group showed a trend toward a higher incidence of SSI (p = 0.10). There was no statistically significant difference regarding improvement in the Japanese Orthopaedic Association scores between the 2 surgical procedures (p = 0.77). The CSAs in the spinal canal and foramen were both significantly improved (p < 0.001).CONCLUSIONSLLIF is a safe, effective, and less invasive procedure with acceptable complication rates for revision surgery for previously decompressed segments. Therefore, LLIF can be an alternative to PLIF/TLIF for restenosis after posterior decompression surgery.

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