Han Weiqi, He Lei, Wang Fei, Zhao Xiaofeng, Jin Cong
Department of Orthopedics, Shaoxing People's Hospital, Shaoxing, China.
Orthop Surg. 2025 Feb;17(2):446-459. doi: 10.1111/os.14315. Epub 2024 Dec 3.
Cage subsidence is a common complication of oblique lumbar interbody fusion (OLIF), particularly in elderly patients with osteoporosis or osteopenia. While bilateral pedicle screw fixation (BPS) is effective in reducing subsidence, it is associated with longer operative times, increased blood loss, and greater tissue trauma. In contrast, anterolateral fixation (AF) is less invasive but linked to higher subsidence rates. Ensuring both minimal invasiveness and adequate stability in OLIF-assisted fixation remains a significant challenge. This study aimed to evaluate the efficacy of combining AF with cement augmentation (AF + CA) in reducing cage subsidence and improving clinical outcomes compared with AF and BPS.
A retrospective analysis was conducted on 138 elderly patients with degenerative lumbar diseases treated with OLIF. Patients were divided into three groups: AF + CA (32 patients), AF (32 patients), and BPS (74 patients). Clinical and radiographic outcomes were compared among the groups, and logistic regression analyses were performed to identify risk factors for cage subsidence after OLIF.
At 1 year postoperatively, the disc height of the AF + CA group was significantly greater than that of the AF group. The cage subsidence rate in the AF + CA group was 24.3%, significantly lower than that in the AF group (48.8%, p < 0.05) and comparable to the BPS group (30.4%). Survivorship curve analysis showed better outcomes in reducing cage subsidence in the AF + CA group compared with the AF group, with no significant difference between the AF + CA and BPS groups. Compared with the AF + CA and BPS groups, the AF group had significantly higher grades and severity of cage subsidence. Fusion rates at 1 year were 91.9% in the AF + CA group, 90.2% in the AF group, and 95.1% in the BPS group, with no significant differences. The AF + CA group had significantly shorter operative times, less intraoperative blood loss, lower VAS scores at 3 days and 1 year postoperatively, and lower ODI scores at 3 days and 3 months compared with the BPS group. Multivariate regression analysis revealed that AF was a significant risk factor for cage subsidence, with an odds ratio of 3.399 compared with AF + CA.
AF + CA effectively reduces cage subsidence in OLIF surgeries, offering results comparable to BPS while providing advantages such as shorter surgical time, reduced blood loss, and improved early postoperative outcomes. AF + CA is a viable alternative, especially for elderly patients with comorbidities who may not tolerate the longer operative durations or greater blood loss associated with BPS.
椎间融合器下沉是斜外侧腰椎椎间融合术（OLIF）的常见并发症，在患有骨质疏松症或骨质减少的老年患者中尤为常见。虽然双侧椎弓根螺钉固定（BPS）在减少下沉方面有效，但它与手术时间延长、失血增加和更大的组织创伤有关。相比之下，前外侧固定（AF）侵入性较小，但与较高的下沉率相关。在OLIF辅助固定中确保最小侵入性和足够稳定性仍然是一项重大挑战。本研究旨在评估与AF和BPS相比，AF联合骨水泥强化（AF + CA）在减少椎间融合器下沉和改善临床结果方面的疗效。
对138例接受OLIF治疗的老年退行性腰椎疾病患者进行回顾性分析。患者分为三组：AF + CA组（32例）、AF组（32例）和BPS组（74例）。比较各组的临床和影像学结果，并进行逻辑回归分析以确定OLIF后椎间融合器下沉的危险因素。
术后1年，AF + CA组的椎间盘高度明显大于AF组。AF + CA组的椎间融合器下沉率为24.3%，明显低于AF组（48.8%，p < 0.05），与BPS组（30.4%）相当。生存曲线分析显示，与AF组相比，AF + CA组在减少椎间融合器下沉方面效果更好，AF + CA组与BPS组之间无显著差异。与AF + CA组和BPS组相比，AF组的椎间融合器下沉分级和严重程度明显更高。1年时的融合率在AF + CA组为91.9%，AF组为90.2%，BPS组为95.1%，无显著差异。与BPS组相比，AF + CA组的手术时间明显更短，术中失血量更少，术后3天和1年时的VAS评分更低，术后3天和3个月时的ODI评分更低。多变量回归分析显示，AF是椎间融合器下沉的一个重要危险因素，与AF + CA组相比，优势比为3.399。
AF + CA在OLIF手术中有效减少椎间融合器下沉，其结果与BPS相当，同时具有手术时间短、失血少和术后早期结果改善等优势。AF + CA是一种可行的替代方案，尤其适用于患有合并症、可能无法耐受与BPS相关的较长手术时间或较多失血量的老年患者。
