Shen Shufeng, You Xinmao, Ren Yingqing, Ye Senqi
Department of Spinal Surgery, Yuyao People's Hospital, Zhejiang Province, China.
Department of Spinal Surgery, Yuyao People's Hospital, Zhejiang Province, China.
World Neurosurg. 2024 Mar;183:180-186. doi: 10.1016/j.wneu.2023.12.110. Epub 2023 Dec 23.
The aim of this systematic review was to evaluate the risk factors for cage subsidence (CS) after oblique lumbar interbody fusion (OLIF).
The cohort and case-control studies which reporting potential risk factors for CS following OLIF were searched in PubMed, Embase, and Web of Science from database inception to June 17, 2023. Two researchers independently screened the literature, extracted data, and evaluated the quality of the literature according to the Newcastle Ottawa Scale. RevMan5.3 software was used for Meta analysis. χ statistics and I statistics were used to evaluate heterogeneity, and the analysis results were represented by forest plots.
A total of 8 studies with 280 cases of CS from 832 patients who underwent OLIF met the inclusion criteria. Elderly patients over 60 years old (odds ratio [OR] 2.44, 95% CI 1.38-4.31, P = 0.002), osteoporosis (OR 4.18, 95% CI 2.30-7.61, P = 0.002), end plate injury (OR 5.72, 95% CI 2.32-14.11, P = 0.0002), and overdistraction of intervertebral space (OR 1.67, 95% CI 1.3 2-2.11, P < 0.0001) were potential risk factors, while Hounsfield units value of the vertebral body (OR 0.97, 95% CI 0.95-1.00, P = 0.02) is a protective factor. The number of operative segments did not increase the risk of CS.
Older age, osteoporosis, endplate injury, and overdistraction of the intervertebral space may increase the risk of CS after OLIF. Although the incidence rate of CS is low, implementing effective preventions is a priority for clinicians based on these risk factors.
本系统评价旨在评估斜外侧腰椎椎间融合术（OLIF）后椎间融合器下沉（CS）的危险因素。
在PubMed、Embase和Web of Science数据库中检索自建库至2023年6月17日报道OLIF术后CS潜在危险因素的队列研究和病例对照研究。两名研究人员独立筛选文献、提取数据，并根据纽卡斯尔渥太华量表评估文献质量。使用RevMan5.3软件进行Meta分析。采用χ统计量和I统计量评估异质性，分析结果以森林图表示。
共有8项研究符合纳入标准，涉及832例行OLIF手术患者中的280例CS病例。60岁以上老年患者（比值比[OR]2.44，95%可信区间[CI]1.38 - 4.31，P = 0.002）、骨质疏松症（OR 4.18，95%CI 2.30 - 7.61，P = 0.002）、终板损伤（OR 5.72，95%CI 2.32 - 14.11，P = 0.0002）和椎间间隙过度撑开（OR 1.67，95%CI 1.32 - 2.11，P < 0.0001）为潜在危险因素，而椎体的Hounsfield单位值（OR 0.97，95%CI 0.95 - 1.00，P = 0.02）为保护因素。手术节段数量并未增加CS的风险。
年龄较大、骨质疏松症、终板损伤和椎间间隙过度撑开可能增加OLIF术后CS的风险。尽管CS的发生率较低，但基于这些危险因素实施有效的预防措施是临床医生的首要任务。
