Journal Article

Clinical and radiological evaluation of cage subsidence following oblique lumbar interbody fusion combined with anterolateral fixation

Wang, Xiandi, Yang, Zhiqiang, Lu, Yufei, Zeng, Jiancheng, Pu, Xingxiao, Xie, Tianhang, Zhao, Long

2022

Overview

Background Cage subsidence (CS) 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 combined with anterolateral fixation, and determine its radiological characteristics as well as related risk factors. Methods Two hundred and forty-two patients who 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 of disk height (DH) decrease during follow-up: no CS (DH decrease ≤ 2 mm), mild CS (2 mm < DH decrease ≤ 4 mm) and severe CS (DH decrease > 4 mm). The clinical and radiological results were compared between groups to evaluate 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 was mainly identified within 1 month postoperatively, it 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 factors for CS. Additionally, flat disk space and DH over-distraction were also correlated with an increased probability of CS.

• Publisher: BioMed Central,BioMed Central Ltd,BMC
• Subject: Cage subsidence / Clinical effects / Complications / Complications and side effects / Epidemiology / Humans / Internal Medicine / Lumbar Vertebrae - diagnostic imaging / Lumbar Vertebrae - surgery / Lumbosacral Region / Medicine / Medicine & Public Health / Oblique lumbar interbody fusion / Orthopedics / Postoperative Complications - diagnostic imaging / Postoperative Complications - etiology / Radiological characteristics / Rehabilitation / Retrospective Studies / Rheumatology / Risk factors / Spinal fusion / Spinal Fusion - adverse effects / Spinal Fusion - methods / Sports Medicine / Statistics / Surgery / Treatment Outcome