Department of Orthopedics Surgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
Department of Orthopedics Surgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
J Clin Neurosci. 2024 Nov;129:110818. doi: 10.1016/j.jocn.2024.110818. Epub 2024 Sep 7.
Lateral lumbar interbody fusion (LLIF) is a minimally invasive fusion technique that can be performed with lateral plate. Insufficient contact between the endplate and bone graft may result in cage subsidence. This study aimed to investigate the potential risk factor for high-grade cage subsidence (HCS) occurring after LLIF supplemented with lateral plate.
Between June 2017 and February 2023, 121 patients (48 males, 73 females; mean age 63.0 years; minimum follow-up period 12 months) undergoing LLIF supplemented with lateral plate were retrospectively reviewed. The incidence of HCS was assessed, and patients were categorized into HCS group or non-HCS group based on the occurrence of HCS. A revision surgery of posterior pedicle screw fixation was performed in patients with cage subsidence and complained with intolerable back pain or radicular symptoms. Comparative analyses were performed on demographic characteristics, surgical variables, and parameters related to endplate-bone graft contact between the two groups. Multivariable logistic regression analysis was employed to identify the potential risk factors associated with HCS. The receiver operating characteristic (ROC) analysis was used to calculate the cutoff values for the risk factors. Clinical outcomes were evaluated using Oswestry Disability Index (ODI), and radiographic fusion at the final follow-up was assessed based on the Bridwell grading system.
The HCS group comprised 12 patients, while the non-HCS group included 109 patients. The incidence of HCS occurring after LLIF supplemented with lateral plate was 9.9 %. Compared to non-HCS group, patients in HCS group had lower sagittal and coronal endplate-bone graft contact rates and larger cage-endplate angles. Low sagittal (OR, 1.099; 95 % CI, 1.033-1.169; P=0.003) and low coronal (OR, 1.149, 95 % CI, 1.061-1.243, P=0.001) endplate-bone graft contact rates were determined to be correlated with HCS. The cutoff value of the sagittal and coronal endplate-bone graft contact rate was 63.5 % and 60.9 %. Eleven (91.7 %) patients in HCS group underwent revision posterior pedicle screw fixation. Both HCS and non-HCS groups experienced significant improvements in ODI at the final follow-up, while there were no differences between groups. Ninety-five (87.2 %) patients in non-HCS group, and nine (81.8 %) of the 11 patients who underwent revision surgery in HCS group achieved radiographic fusion at the final follow-up.
The incidence of HCS occurring after LLIF supplemented with lateral plate was 9.9%. Insufficient endplate-bone graft contact is an important risk factor of HCS, and sagittal and coronal endplate-bone graft contact rates can be used as effective predictors for HCS.
侧方腰椎体间融合术（LLIF）是一种微创融合技术，可通过侧方板进行。终板与骨移植物之间的接触不足可能导致 cage 下沉。本研究旨在探讨 LLIF 联合侧方板后发生高级别 cage 下沉（HCS）的潜在危险因素。
回顾性分析 2017 年 6 月至 2023 年 2 月间接受 LLIF 联合侧方板治疗的 121 例患者（48 例男性，73 例女性；平均年龄 63.0 岁；最小随访时间 12 个月）。评估 HCS 的发生率，并根据 HCS 的发生情况将患者分为 HCS 组或非 HCS 组。对 cage 下沉且有难以忍受的腰背疼痛或神经根症状的患者进行后路椎弓根螺钉固定翻修手术。对两组之间的人口统计学特征、手术变量以及终板-骨移植物接触相关参数进行比较分析。采用多变量逻辑回归分析确定与 HCS 相关的潜在危险因素。使用受试者工作特征（ROC）分析计算危险因素的截断值。采用 Oswestry 功能障碍指数（ODI）评估临床结果，根据 Bridwell 分级系统评估末次随访时的影像学融合情况。
HCS 组包括 12 例患者，非 HCS 组包括 109 例患者。LLIF 联合侧方板治疗后 HCS 的发生率为 9.9%。与非 HCS 组相比，HCS 组的矢状位和冠状位终板-骨移植物接触率较低，cage-终板角度较大。低矢状位（OR，1.099；95%CI，1.033-1.169；P=0.003）和低冠状位（OR，1.149，95%CI，1.061-1.243，P=0.001）终板-骨移植物接触率与 HCS 相关。矢状位和冠状位终板-骨移植物接触率的截断值分别为 63.5%和 60.9%。HCS 组 11 例（91.7%）患者接受了后路椎弓根螺钉固定翻修手术。HCS 组和非 HCS 组在末次随访时 ODI 均显著改善，但两组间无差异。非 HCS 组 95 例（87.2%）患者和 HCS 组 11 例接受翻修手术的患者中，9 例（81.8%）在末次随访时达到影像学融合。
LLIF 联合侧方板治疗后 HCS 的发生率为 9.9%。终板-骨移植物接触不足是 HCS 的重要危险因素，矢状位和冠状位终板-骨移植物接触率可作为 HCS 的有效预测指标。
