Introduction: Cage impactions (CI) of Oblique Lumbar Interbody Fusion (OLIF) appear to be a frequent mechanical complication with a potential functional impact.
Objectives: To determine the rate of CI occurrence, their risk factors and clinical implications in the case of combined single-level arthrodesis.
Method: A retrospective analysis of prospectively collected data was performed. All our patients with degenerative spondylolisthesis initially underwent OLIF combined with pedicle screw fixation (PSF). Intraoperative control with an image intensifier and a standard radiograph in the immediate postoperative period made it possible to assess the occurrence of CI, depending on the position of the implant. Secondary subsidence was sought on the standing radiological examination using EOS biplanar radiography during follow-up. The pelvic parameters were analyzed, as well as the occurrence of bone fusion. The clinical evaluation was made at≥1 year, by the Oswestry Disability Index (ODI), the walking distance (WD) and the Visual Analogue Scale (VAS).
Results: In all, 130 patients out of the 131 included were analyzed. A CI occurred in 25.3% (n=33) of cases and of these, 94% (n=32) occurred intraoperatively. Postmenopausal women had more CI with an odds ratio (OR) of 5.8 (P=0.034). The "CI" group had a 9.5% lower ODI score than the "non-CI" group (P=0.0040), but both provided excellent ODI gains of 30.8±16 and 32.9±15.5% (P<0.0001). An "anterior" position of the implant allowed a greater gain in lumbar lordosis (P<0.001) but was associated with greater CI occurrence (P<0.001), with an OR of 6.75 (P=0.0018).
Conclusion: The occurrence of intraoperative cage impaction is a frequent event when performing OLIF. Postmenopausal women have an approximately 6 times greater risk of impaction than men, and patients with an "anterior" implant placement have a 7 times greater risk than with central placement. The negative impact of cage impactions on the clinical score (ODI) was significant after one year of follow-up.
Level Of Evidence: IV, non-comparative cohort study.
Download full-text PDF |
Source |
|---|---|
| http://dx.doi.org/10.1016/j.otsr.2022.103385 | DOI Listing |
Publication Analysis
Top Keywords
Similar Publications
Kyphectomy followed by self-sliding pedicle screw and translumbosacral rod impaction and fixation: a novel growth-friendly technique in myelomeningocele patients.
Spine Deform
January 2025
Pediatrics and Neurosurgery, Cedars Sinai Medical Center, Los Angeles, CA, USA.
Introduction: Congenital lumbar kyphosis is present in about 15% of patients with myelomeningocele. Worsening of deformity with complications such as chronic skin ulcers and bone exposure is common. In patients under 8 years of age, treatment becomes even more challenging: in addition to resecting the apex of the kyphotic deformity, we should ideally stabilize the spine with fixation methods that do not interrupt the growth of the rib cage, associated with the challenging pelvic fixation in this population.
View Article and Find Full Text PDFA Neglected Fracture of Acetabulum Treated With Total Hip Replacement.
Cureus
June 2024
Orthopaedics, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth, Pune (Deemed to Be University), Pune, IND.
Total hip replacement (THR) for osteoarthritis or inflammatory arthritis yields better outcomes than THR for patients with neglected acetabular fractures. The inferior clinical results mostly arise from an unforeseen bone deficit, making the treatment more time-consuming and complex for instances requiring acetabular restoration and bone grafting. There is a lack of research on the clinical results of THR in cases where acetabular fractures have been overlooked.
View Article and Find Full Text PDFEvaluation and Management of Acetabular Bone Loss in Revision Total Hip Arthroplasty: A 10-year Update.
J Am Acad Orthop Surg
May 2024
From the Department of Arthroplasty, Sancheti Institute for Orthopaedics and Rehabilitation, Pune, Maharashtra, India (Sanghavi), Department of Orthopaedic Surgery, RUSH University Medical Center, Chicago, IL (Paprosky), Department of Orthopaedic Surgery, Pennsylvania Hospital, University of Pennsylvania, Philadelphia, PA (Sheth).
Acetabular bone loss continues to be one of the most complex and challenging scenarios facing the orthopaedic surgeon. Preoperative planning and classification systems essentially have remained the same, with the Paprosky classification still being the most commonly used. Careful radiological assessment with well-defined criteria can accurately diagnose acetabular bone loss patterns with an associated chronic pelvic discontinuity before surgery.
View Article and Find Full Text PDFMinimally Invasive Transforaminal Lumbar Interbody Fusion with Expandable Cages.
JBJS Essent Surg Tech
May 2023
University of Melbourne, Melbourne, Victoria, Australia.
Background: Minimally invasive surgical transforaminal lumbar interbody fusion (MIS-TLIF) is an increasingly common procedure for the treatment of lumbar degenerative pathologies. The MIS-TLIF technique often results in less soft-tissue injury compared with the open TLIF technique, reducing postoperative pain and recovery time. However, the narrow surgical aperture of this minimally invasive technique has increased the difficulty of interbody cage placement.
View Article and Find Full Text PDFEndplate Trauma During Implant Insertion Affects the Expulsion Risk of Anterior Lumbar Interbody Fusion Devices.
Cureus
March 2023
Orthopedics, Ortho HUB Ventures UG, Filderstadt, DEU.
Background Anterior cage migration in anterior lumbar interbody fusion is a serious complication. To address this risk, cage designs are now available with integrated screw or blade fixation or specially designed surface geometries with large teeth or ridges. However, the implantation technique itself has not yet been addressed as a potential risk factor for cage migration.
View Article and Find Full Text PDFWant AI Summaries of new PubMed Abstracts delivered to your In-box?
Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!