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03.04.2023 | Originalien

Cage subsidence—A multifactorial matter!

verfasst von: Periklis Godolias, MD, Zachary L. Tataryn, MD, Jonathan Plümer, MD, Charlotte Cibura, MD, Yevgeniy Freyvert, MD, Hansjörg Heep, MD, Marcel Dudda, MD, Thomas A. Schildhauer, MD, Jens R. Chapman, MD, Rod J. Oskouian, MD

Erschienen in: Die Orthopädie | Ausgabe 8/2023

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Abstract

Study design

Retrospective cohort study

Objective

Wider cages are associated with improved decompression and reduced subsidence, but variation in cage physical properties limits consistent outcome analysis after thoracolumbar interbody fusion. This study investigated cage subsidence and its relationship to lateral and posterior approaches with a focus on the hypothesis that the larger surface area of lateral cages results in lower subsidence rates.

Methods

This study retrospectively reviewed 194 patients who underwent interbody fusion between 2016 and 2019 with a primary outcome of cage subsidence. Secondary outcomes were cage distribution (patients, approaches, expandability), cage dimensions, t‑scores, length of hospital stay, blood loss, surgical time, and pelvic incidence-lumbar lordosis (PI-LL) mismatch.

Results

Medical records were reviewed for 194 patients receiving 387 cages at 379 disc levels. Subsidence was identified in 35.1% of lateral cages, 40.9% of posterior cages, and 36.3% of all cages. Lower surface area (p = 0.008) and cage expandability were associated with subsidence risk. Lower anteroposterior cage length proved to be a significant factor in the subsidence of posteriorly placed cages (p = 0.007). Osteopenic and osteoporotic patients experienced cage subsidence 36.8% of the time compared to 3.5% of patients with normal t‑scores (p = 0.001). Cage subsidence correlated with postoperative deterioration of the PI-LL mismatch (p = 0.03). Patients receiving fusion augmentation with bone morphogenic protein experienced higher fusion rates (p < 0.01).

Conclusion

Cage subsidence is a common complication that can significantly impact operative outcomes following thoracolumbar interbody fusion. Low t‑scores, smaller surface area, cage expandability, and lower cage length in posterior approaches contribute significantly to cage subsidence.

Bach K, Ford J, Foley R et al (2019) Morphometric analysis of lumbar intervertebral disc height: an imaging study. World Neurosurg. https://doi.org/10.1016/j.wneu.2018.12.014CrossRefPubMed

Chang C‑C, Chou D, Pennicooke B et al (2021) Long-term radiographic outcomes of expandable versus static cages in transforaminal lumbar interbody fusion. J Neurosurg Spine. https://doi.org/10.3171/2020.6.SPINE191378CrossRefPubMed

Choi JY, Sung KH (2006) Subsidence after anterior lumbar interbody fusion using paired stand-alone rectangular cages. Eur Spine J. https://doi.org/10.1007/s00586-004-0817-yCrossRefPubMedPubMedCentral

Fogel GR, Toohey JS, Neidre A, Brantigan JW (2008) Fusion assessment of posterior lumbar interbody fusion using radiolucent cages: X‑ray films and helical computed tomography scans compared with surgical exploration of fusion. Spine J. https://doi.org/10.1016/j.spinee.2007.03.013CrossRefPubMed

Frisch RF, Luna IY, Brooks DM et al (2018) Clinical and radiographic analysis of expandable versus static lateral lumbar interbody fusion devices with two-year follow-up. J Spine Surg. https://doi.org/10.21037/jss.2018.03.16CrossRefPubMedPubMedCentral

Lang G, Navarro-Ramirez R, Gandevia L et al (2017) Elimination of subsidence with 26-mm-wide cages in extreme lateral interbody fusion. World Neurosurg 104:644–652. https://doi.org/10.1016/j.wneu.2017.05.035CrossRefPubMed

Li YM, Frisch RF, Huang Z et al (2020) Comparative effectiveness of expandable versus static Interbody spacers via MIS LLIF: a 2‑year radiographic and clinical outcomes study. Global Spine J 10:998–1005. https://doi.org/10.1177/2192568219886278CrossRefPubMed

Macki M, Anand SK, Surapaneni A et al (2019) Subsidence rates after lateral lumbar Interbody fusion: a systematic review. World Neurosurg 122:599–606. https://doi.org/10.1016/j.wneu.2018.11.121CrossRefPubMed

Marchi L, Abdala N, Oliveira L et al (2013) Radiographic and clinical evaluation of cage subsidence after stand-alone lateral interbody fusion. J Neurosurg Spine. https://doi.org/10.3171/2013.4.SPINE12319CrossRefPubMed

10.

Ozgur BM, Aryan HE, Pimenta L, Taylor WR (2006) Extreme Lateral Interbody Fusion (XLIF): a novel surgical technique for anterior lumbar interbody fusion. Spine J 6:435–443. https://doi.org/10.1016/j.spinee.2005.08.012CrossRefPubMed

11.

Pekmezci M, Tang JA, Cheng L et al (2016) Comparison of expandable and fixed Interbody cages in a human cadaver corpectomy model. Clin Spine Surg. https://doi.org/10.1097/BSD.0b013e31826eb0f7CrossRefPubMed

12.

Rodgers WB, Gerber EJ, Patterson J (2011) Intraoperative and early postoperative complications in extreme lateral interbody fusion: an analysis of 600 cases. Spine 36:26–32. https://doi.org/10.1097/BRS.0b013e3181e1040aCrossRefPubMed

13.

Salzmann SN, Shue J, Hughes AP (2017) Lateral lumbar interbody fusion-outcomes and complications. Curr Rev Musculoskelet Med 10:539–546. https://doi.org/10.1007/s12178-017-9444-1CrossRefPubMedPubMedCentral

14.

Schiffman M, Brau SA, Henderson R, Gimmestad G (2003) Bilateral implantation of low-profile interbody fusion cages: subsidence, lordosis, and fusion analysis. Spine J. https://doi.org/10.1016/S1529-9430(03)00145-1CrossRefPubMed

15.

Sharma AK, Kepler CK, Girardi FP et al (2011) Lateral lumbar interbody fusion: clinical and radiographic outcomes at 1 year: a preliminary report. J Spinal Disord Tech 24:242–250. https://doi.org/10.1097/BSD.0b013e3181ecf995CrossRefPubMed

16.

Stickley C, Philipp T, Wang E et al (2021) Expandable cages increase the risk of intraoperative subsidence but do not improve perioperative outcomes in single level transforaminal lumbar interbody fusion. Spine J. https://doi.org/10.1016/j.spinee.2020.08.019CrossRefPubMed

17.

Tartara F, Bongetta D, Pilloni G et al (2020) Custom-made trabecular titanium implants for the treatment of lumbar degenerative discopathy via ALIF/XLIF techniques: rationale for use and preliminary results. Eur Spine J 29:314–320. https://doi.org/10.1007/s00586-019-06191-yCrossRefPubMed

18.

Tempel ZJ, McDowell MM, Panczykowski DM et al (2018) Graft subsidence as a predictor of revision surgery following stand-alone lateral lumbar interbody fusion. J Neurosurg Spine. https://doi.org/10.3171/2017.5.SPINE16427CrossRefPubMed

19.

Tohmeh AG, Khorsand D, Watson B, Zielinski X (2014) Radiographical and clinical evaluation of extreme lateral Interbody fusion. Spine. https://doi.org/10.1097/BRS.0000000000000645CrossRefPubMed

Titel: Cage subsidence—A multifactorial matter!
verfasst von: Periklis Godolias, MD
Zachary L. Tataryn, MD
Jonathan Plümer, MD
Charlotte Cibura, MD
Yevgeniy Freyvert, MD
Hansjörg Heep, MD
Marcel Dudda, MD
Thomas A. Schildhauer, MD
Jens R. Chapman, MD
Rod J. Oskouian, MD
Publikationsdatum: 03.04.2023
Verlag: Springer Medizin
Erschienen in: Die Orthopädie / Ausgabe 8/2023
Print ISSN: 2731-7145
Elektronische ISSN: 2731-7153
DOI: https://doi.org/10.1007/s00132-023-04363-9

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Cage subsidence—A multifactorial matter!