Radiographic and clinical evaluation of cage subsidence after stand-alone lateral interbody fusion Clinical article

Detalhes bibliográficos
Autor(a) principal: Marchi, Luis [UNIFESP]
Data de Publicação: 2013
Outros Autores: Abdala, Nitamar [UNIFESP], Oliveira, Leonardo, Amaral, Rodrigo, Coutinho, Etevaldo, Pimenta, Luiz
Tipo de documento: Artigo
Idioma: eng
Título da fonte: Repositório Institucional da UNIFESP
Texto Completo: http://repositorio.unifesp.br/handle/11600/36458
http://dx.doi.org/10.3171/2013.4.SPINE12319
Resumo: Object. Indirect decompression of the neural structures through interbody distraction and fusion in the lumbar spine is feasible, but cage subsidence may limit maintenance of the initial decompression. the influence of interbody cage size on subsidence and symptoms in minimally invasive lateral interbody fusion is heretofore unreported. the authors report the rate of cage subsidence after lateral interbody fusion, examine the clinical effects, and present a subsidence classification scale.Methods. the study was performed as an institutional review board approved prospective, nonrandomized, comparative, single-center radiographic and clinical evaluation. Stand-alone short-segment (1- or 2-level) lateral lumbar interbody fusion was investigated with 12 months of postoperative follow-up. Two groups were compared. Forty-six patients underwent treatment at 61 lumbar levels with standard interbody cages (18 mm anterior/posterior dimension), and 28 patients underwent treatment at 37 lumbar levels with wide cages (22 mm). Standing lateral radiographs were used to measure segmental lumbar lordosis, disc height, and rate of subsidence. Subsidence was classified using the following scale: Grade 0, 0%-24% loss of postoperative disc height; Grade I, 25%-49%; Grade II, 50%-74%; and Grade III, 75%-100%. Fusion status was assessed on CT scanning, and pain and disability were assessed using the visual analog scale and Oswestry Disability Index. Complications and reoperations were recorded.Results. Pain and disability improved similarly in both groups. While significant gains in segmental lumbar lordosis and disc height were observed overall, the standard group experienced less improvement due to the higher rate of interbody graft subsidence. A difference in the rate of subsidence between the groups was evident at 6 weeks (p = 0.027), 3 months (p = 0.042), and 12 months (p = 0.047). At 12 months, 70% in the standard group and 89% in the wide group had Grade 0 or I subsidence, and 30% in the standard group and 11% in wide group had Grade II or III subsidence. Subsidence was detected early (6 weeks), at which point it was correlated with transient clinical worsening, although progression of subsidence was not observed after the 6-week time point. Moreover, subsidence occurred predominantly (68%) in the inferior endplate. Fusion rate was not affected by cage dimension (p > 0.999) or by incidence of subsidence (p = 0.383).Conclusions. Wider cages avoid subsidence and better restore segmental lordosis in stand-alone lateral interbody fusion. Cage subsidence is identified early in follow-up and can be accessed using the proposed classification scale.
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spelling Marchi, Luis [UNIFESP]Abdala, Nitamar [UNIFESP]Oliveira, LeonardoAmaral, RodrigoCoutinho, EtevaldoPimenta, LuizUniversidade Federal de São Paulo (UNIFESP)Inst Patol ColunaUniv Calif San Diego2016-01-24T14:31:55Z2016-01-24T14:31:55Z2013-07-01Journal of Neurosurgery-spine. Rolling Meadows: Amer Assoc Neurological Surgeons, v. 19, n. 1, p. 110-118, 2013.1547-5654http://repositorio.unifesp.br/handle/11600/36458http://dx.doi.org/10.3171/2013.4.SPINE1231910.3171/2013.4.SPINE12319WOS:000320739600016Object. Indirect decompression of the neural structures through interbody distraction and fusion in the lumbar spine is feasible, but cage subsidence may limit maintenance of the initial decompression. the influence of interbody cage size on subsidence and symptoms in minimally invasive lateral interbody fusion is heretofore unreported. the authors report the rate of cage subsidence after lateral interbody fusion, examine the clinical effects, and present a subsidence classification scale.Methods. the study was performed as an institutional review board approved prospective, nonrandomized, comparative, single-center radiographic and clinical evaluation. Stand-alone short-segment (1- or 2-level) lateral lumbar interbody fusion was investigated with 12 months of postoperative follow-up. Two groups were compared. Forty-six patients underwent treatment at 61 lumbar levels with standard interbody cages (18 mm anterior/posterior dimension), and 28 patients underwent treatment at 37 lumbar levels with wide cages (22 mm). Standing lateral radiographs were used to measure segmental lumbar lordosis, disc height, and rate of subsidence. Subsidence was classified using the following scale: Grade 0, 0%-24% loss of postoperative disc height; Grade I, 25%-49%; Grade II, 50%-74%; and Grade III, 75%-100%. Fusion status was assessed on CT scanning, and pain and disability were assessed using the visual analog scale and Oswestry Disability Index. Complications and reoperations were recorded.Results. Pain and disability improved similarly in both groups. While significant gains in segmental lumbar lordosis and disc height were observed overall, the standard group experienced less improvement due to the higher rate of interbody graft subsidence. A difference in the rate of subsidence between the groups was evident at 6 weeks (p = 0.027), 3 months (p = 0.042), and 12 months (p = 0.047). At 12 months, 70% in the standard group and 89% in the wide group had Grade 0 or I subsidence, and 30% in the standard group and 11% in wide group had Grade II or III subsidence. Subsidence was detected early (6 weeks), at which point it was correlated with transient clinical worsening, although progression of subsidence was not observed after the 6-week time point. Moreover, subsidence occurred predominantly (68%) in the inferior endplate. Fusion rate was not affected by cage dimension (p > 0.999) or by incidence of subsidence (p = 0.383).Conclusions. Wider cages avoid subsidence and better restore segmental lordosis in stand-alone lateral interbody fusion. Cage subsidence is identified early in follow-up and can be accessed using the proposed classification scale.Universidade Federal de São Paulo, Dept Imaging Diag, São Paulo, BrazilInst Patol Coluna, Dept Minimally Invas Surg, São Paulo, BrazilUniv Calif San Diego, Dept Neurosurg, San Diego, CA 92103 USAUniversidade Federal de São Paulo, Dept Imaging Diag, São Paulo, BrazilWeb of Science110-118engAmer Assoc Neurological SurgeonsJournal of Neurosurgery-spineminimally invasivecomplicationlumbar fusionXLIFspinearthrodesisspinal fusionRadiographic and clinical evaluation of cage subsidence after stand-alone lateral interbody fusion Clinical articleinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articleinfo:eu-repo/semantics/openAccessreponame:Repositório Institucional da UNIFESPinstname:Universidade Federal de São Paulo (UNIFESP)instacron:UNIFESP11600/364582022-06-02 09:05:56.106metadata only accessoai:repositorio.unifesp.br:11600/36458Repositório InstitucionalPUBhttp://www.repositorio.unifesp.br/oai/requestopendoar:34652023-05-25T12:13:51.579396Repositório Institucional da UNIFESP - Universidade Federal de São Paulo (UNIFESP)false
dc.title.en.fl_str_mv Radiographic and clinical evaluation of cage subsidence after stand-alone lateral interbody fusion Clinical article
title Radiographic and clinical evaluation of cage subsidence after stand-alone lateral interbody fusion Clinical article
spellingShingle Radiographic and clinical evaluation of cage subsidence after stand-alone lateral interbody fusion Clinical article
Marchi, Luis [UNIFESP]
minimally invasive
complication
lumbar fusion
XLIF
spine
arthrodesis
spinal fusion
title_short Radiographic and clinical evaluation of cage subsidence after stand-alone lateral interbody fusion Clinical article
title_full Radiographic and clinical evaluation of cage subsidence after stand-alone lateral interbody fusion Clinical article
title_fullStr Radiographic and clinical evaluation of cage subsidence after stand-alone lateral interbody fusion Clinical article
title_full_unstemmed Radiographic and clinical evaluation of cage subsidence after stand-alone lateral interbody fusion Clinical article
title_sort Radiographic and clinical evaluation of cage subsidence after stand-alone lateral interbody fusion Clinical article
author Marchi, Luis [UNIFESP]
author_facet Marchi, Luis [UNIFESP]
Abdala, Nitamar [UNIFESP]
Oliveira, Leonardo
Amaral, Rodrigo
Coutinho, Etevaldo
Pimenta, Luiz
author_role author
author2 Abdala, Nitamar [UNIFESP]
Oliveira, Leonardo
Amaral, Rodrigo
Coutinho, Etevaldo
Pimenta, Luiz
author2_role author
author
author
author
author
dc.contributor.institution.none.fl_str_mv Universidade Federal de São Paulo (UNIFESP)
Inst Patol Coluna
Univ Calif San Diego
dc.contributor.author.fl_str_mv Marchi, Luis [UNIFESP]
Abdala, Nitamar [UNIFESP]
Oliveira, Leonardo
Amaral, Rodrigo
Coutinho, Etevaldo
Pimenta, Luiz
dc.subject.eng.fl_str_mv minimally invasive
complication
lumbar fusion
XLIF
spine
arthrodesis
spinal fusion
topic minimally invasive
complication
lumbar fusion
XLIF
spine
arthrodesis
spinal fusion
description Object. Indirect decompression of the neural structures through interbody distraction and fusion in the lumbar spine is feasible, but cage subsidence may limit maintenance of the initial decompression. the influence of interbody cage size on subsidence and symptoms in minimally invasive lateral interbody fusion is heretofore unreported. the authors report the rate of cage subsidence after lateral interbody fusion, examine the clinical effects, and present a subsidence classification scale.Methods. the study was performed as an institutional review board approved prospective, nonrandomized, comparative, single-center radiographic and clinical evaluation. Stand-alone short-segment (1- or 2-level) lateral lumbar interbody fusion was investigated with 12 months of postoperative follow-up. Two groups were compared. Forty-six patients underwent treatment at 61 lumbar levels with standard interbody cages (18 mm anterior/posterior dimension), and 28 patients underwent treatment at 37 lumbar levels with wide cages (22 mm). Standing lateral radiographs were used to measure segmental lumbar lordosis, disc height, and rate of subsidence. Subsidence was classified using the following scale: Grade 0, 0%-24% loss of postoperative disc height; Grade I, 25%-49%; Grade II, 50%-74%; and Grade III, 75%-100%. Fusion status was assessed on CT scanning, and pain and disability were assessed using the visual analog scale and Oswestry Disability Index. Complications and reoperations were recorded.Results. Pain and disability improved similarly in both groups. While significant gains in segmental lumbar lordosis and disc height were observed overall, the standard group experienced less improvement due to the higher rate of interbody graft subsidence. A difference in the rate of subsidence between the groups was evident at 6 weeks (p = 0.027), 3 months (p = 0.042), and 12 months (p = 0.047). At 12 months, 70% in the standard group and 89% in the wide group had Grade 0 or I subsidence, and 30% in the standard group and 11% in wide group had Grade II or III subsidence. Subsidence was detected early (6 weeks), at which point it was correlated with transient clinical worsening, although progression of subsidence was not observed after the 6-week time point. Moreover, subsidence occurred predominantly (68%) in the inferior endplate. Fusion rate was not affected by cage dimension (p > 0.999) or by incidence of subsidence (p = 0.383).Conclusions. Wider cages avoid subsidence and better restore segmental lordosis in stand-alone lateral interbody fusion. Cage subsidence is identified early in follow-up and can be accessed using the proposed classification scale.
publishDate 2013
dc.date.issued.fl_str_mv 2013-07-01
dc.date.accessioned.fl_str_mv 2016-01-24T14:31:55Z
dc.date.available.fl_str_mv 2016-01-24T14:31:55Z
dc.type.status.fl_str_mv info:eu-repo/semantics/publishedVersion
dc.type.driver.fl_str_mv info:eu-repo/semantics/article
format article
status_str publishedVersion
dc.identifier.citation.fl_str_mv Journal of Neurosurgery-spine. Rolling Meadows: Amer Assoc Neurological Surgeons, v. 19, n. 1, p. 110-118, 2013.
dc.identifier.uri.fl_str_mv http://repositorio.unifesp.br/handle/11600/36458
http://dx.doi.org/10.3171/2013.4.SPINE12319
dc.identifier.issn.none.fl_str_mv 1547-5654
dc.identifier.doi.none.fl_str_mv 10.3171/2013.4.SPINE12319
dc.identifier.wos.none.fl_str_mv WOS:000320739600016
identifier_str_mv Journal of Neurosurgery-spine. Rolling Meadows: Amer Assoc Neurological Surgeons, v. 19, n. 1, p. 110-118, 2013.
1547-5654
10.3171/2013.4.SPINE12319
WOS:000320739600016
url http://repositorio.unifesp.br/handle/11600/36458
http://dx.doi.org/10.3171/2013.4.SPINE12319
dc.language.iso.fl_str_mv eng
language eng
dc.relation.ispartof.none.fl_str_mv Journal of Neurosurgery-spine
dc.rights.driver.fl_str_mv info:eu-repo/semantics/openAccess
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv 110-118
dc.publisher.none.fl_str_mv Amer Assoc Neurological Surgeons
publisher.none.fl_str_mv Amer Assoc Neurological Surgeons
dc.source.none.fl_str_mv reponame:Repositório Institucional da UNIFESP
instname:Universidade Federal de São Paulo (UNIFESP)
instacron:UNIFESP
instname_str Universidade Federal de São Paulo (UNIFESP)
instacron_str UNIFESP
institution UNIFESP
reponame_str Repositório Institucional da UNIFESP
collection Repositório Institucional da UNIFESP
repository.name.fl_str_mv Repositório Institucional da UNIFESP - Universidade Federal de São Paulo (UNIFESP)
repository.mail.fl_str_mv
_version_ 1783460265001484288