Department of Biomedical Engineering, University of Melbourne, Parkville, VIC, 3010, Australia.
Department of Orthopaedics, Royal Melbourne Hospital, Parkville, VIC, 3052, Australia.
J Orthop Surg Res. 2022 Apr 10;17(1):224. doi: 10.1186/s13018-022-03091-8.
BACKGROUND: Lumbar interbody fusion (LIF) is an established surgical intervention for patients with leg and back pain secondary to disc herniation or degeneration. Interbody fusion involves removal of the herniated or degenerated disc and insertion of interbody devices with bone grafts into the remaining cavity. Extensive research has been conducted on operative complications such as a failure of fusion or non-union of the vertebral bodies. Multiple factors including surgical, implant, and patient factors influencing the rate of complications have been identified. Patient factors include age, sex, osteoporosis, and patient anatomy. Complications can also be influenced by the interbody cage design. The geometry of the bony endplates as well as their corresponding material properties guides the design of interbody cages, which vary considerably across patients with spinal disorders. However, studies on the effects of such variations on the rate of complications are limited. Therefore, this study aimed to perform a systematic review of lumbar endplate geometry and material property factors in LIF failure. METHODS: Search keywords included 'factor/cause for spinal fusion failure/cage subsidence/cage migration/non-union', 'lumbar', and 'interbody' in electronic databases PubMed and Scopus with no limits on year of publication. RESULTS: In total, 1341 articles were reviewed, and 29 articles were deemed suitable for inclusion. Adverse events after LIF, such as cage subsidence, cage migration, and non-union, resulted in fusion failure; hence, risk factors for adverse events after LIF, notably those associated with lumbar endplate geometry and material properties, were also associated with fusion failure. Those risk factors were associated with shape, concavity, bone mineral density and stiffness of endplate, segmental disc angle, and intervertebral disc height. CONCLUSIONS: This review demonstrated that decreased contact areas between the cage and endplate, thin and weak bony endplate as well as spinal diseases such as spondylolisthesis and osteoporosis are important causes of adverse events after LIF. These findings will facilitate the selection and design of LIF cages, including customised implants based on patient endplate properties.
背景:腰椎体间融合术(LIF)是一种成熟的手术干预方法,适用于因椎间盘突出或退变导致下肢和背部疼痛的患者。该手术涉及切除突出或退变的椎间盘,并将椎间植入物和骨移植物插入剩余的空腔中。已经对手术并发症(如融合失败或椎体不愈合)进行了广泛的研究。已经确定了影响并发症发生率的多种因素,包括手术、植入物和患者因素。患者因素包括年龄、性别、骨质疏松症和患者解剖结构。椎间笼设计也会影响并发症。骨性终板的几何形状及其相应的材料特性指导着椎间笼的设计,而脊柱疾病患者的椎间笼设计差异很大。然而,关于这些变化对并发症发生率的影响的研究有限。因此,本研究旨在对 LIF 失败中腰椎终板几何形状和材料特性因素进行系统回顾。
方法:在电子数据库 PubMed 和 Scopus 中使用“factor/cause for spinal fusion failure/cage subsidence/cage migration/non-union”、“lumbar”和“interbody”作为搜索关键词,没有对发表年份进行限制。
结果:共回顾了 1341 篇文章,其中 29 篇文章被认为适合纳入。LIF 后的不良事件,如笼沉降、笼迁移和不愈合,导致融合失败;因此,LIF 后不良事件的危险因素,特别是与腰椎终板几何形状和材料特性相关的危险因素,也与融合失败相关。这些危险因素与终板的形状、凹陷、骨密度和刚度、节段性椎间盘角度以及椎间盘高度有关。
结论:本综述表明,笼与终板之间的接触面积减小、终板薄而脆弱以及脊柱疾病(如脊椎滑脱和骨质疏松症)是 LIF 后不良事件的重要原因。这些发现将有助于 LIF 笼的选择和设计,包括基于患者终板特性的定制植入物。
Cochrane Database Syst Rev. 2004-10-18
Cochrane Database Syst Rev. 2018-2-6
Bioengineering (Basel). 2025-3-24
BMC Musculoskelet Disord. 2025-4-3
Eur J Orthop Surg Traumatol. 2022-10
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2021-8-15
Orthop Traumatol Surg Res. 2021-11