Purpose: Implant subsidence is a possible complication of spinal interbody fusion. We aim to evaluate porous titanium cages subsidence, fusion and functional outcomes in patients subjected to oblique lumbar interbody fusion (OLIF) with these novel devices. Methods: Our institutional review board approved a single-center experience which included 60 patients who underwent OLIF from June 2018 to June 2020 utilizing the porous titanium implants. Data was collected in accordance with the Declaration of Helsinki, and written informed consent was obtained. Imaging studies including radiographs 1, 3, 6 and 12 months and computed tomography (CT) scan at 6 months obtained during routine postoperative follow-up visits, were studied for signs of implant subsidence, fusion and clinical parameters to determine the effectiveness of surgery such as Oswestry disability index (ODI). Results: Radiographic subsidence occurred in 1 out of 89 porous titanium interbody cages (1.1%). No subsidence was observed in the posterior screws and rods fixation group (N = 57). However, one case of subsidence occurred in the lateral plate fixation group (N = 3). The subsidence occurred in an osteoporotic elderly patient operated for adjacent segment disease, and she was later revised with posterior instrumentation using cemented screws and rods. She had an uneventful recovery. Fusion rates were evaluated under CT scan at 6 months with a rate of 88%. In terms of clinical outcomes, ODI decreased significantly from 20.3 preop to 10.7 postop with a P-value < 0.05. Conclusions: In our study, the subsidence rate was lower than previously reported in the literature. Also, we had good fusion rates at 6 months likely due to the porous titanium cages use. We had no subsidence in the posterior instrumented group and one case in the lateral fixation group with improved clinical outcomes.
References
[1]
Li, R.J., Li, X.F., Zhou, H. and Jiang, W.M. (2020) Development and Application of Oblique Lumbar Interbody Fusion. Orthopaedic Surgery, 12, 355-365. https://doi.org/10.1111/os.12625
[2]
Sato, J., et al. (2017) Radiographic Evaluation of Indirect Decompression of Mini-Open Anterior Retroperitoneal Lumbar Interbody Fusion: Oblique Lateral Interbody Fusion for Degenerated Lumbar Spondylolisthesis. European Spine Journal, 26, 671-678. https://doi.org/10.1007/s00586-015-4170-0
[3]
Smith, W.D., Christian, G., Serrano, S. and Malone, K.T. (2012). A Comparison of Perioperative Charges and Outcome between Open and Mini-Open Approaches for Anterior Lumbar Discectomy and Fusion. Journal of Clinical Neuroscience, 19, 673-680. https://doi.org/10.1016/j.jocn.2011.09.010
[4]
Lucio, J.C., Vanconia, R.B., Deluzio, K.J., Lehmen, J.A., Rodgers, J.A. and Rodgers, W.B. (2012) Economics of Less Invasive Spinal Surgery: An Analysis of Hospital Cost Differences between Open and Minimally Invasive Instrumented Spinal Fusion Procedures during the Perioperative Period. Risk Management and Healthcare Policy, 5, 65-74. https://doi.org/10.2147/RMHP.S30974
[5]
Alimi, M., Lang, G., Navarro-Ramirez, R., et al. (2018) The Impact of Cage Dimensions, Positioning, and Side of Approach in Extreme Lateral Interbody Fusion. Clinical Spine Surgery, 31, E42-E49. https://doi.org/10.1097/BSD.0000000000000507
[6]
Li, J.X.J., Phan, K. and Mobbs, R. (2017) Oblique Lumbar Interbody Fusion: Technical Aspects, Operative Outcomes, and Complications. World Neurosurgery, 98, 113-123. https://doi.org/10.1016/j.wneu.2016.10.074
[7]
Phan, K., Maharaj, M., Assem, Y. and Mobbs, R.J. (2016) Review of Early Clinical Results and Complications Associated with Oblique Lumbar Interbody Fusion (OLIF). Journal of Clinical Neuroscience, 31, 23-29. https://doi.org/10.1016/j.jocn.2016.02.030
[8]
Marchi, L., Abdala, N., Oliveira, L., Amaral, R., Coutinho, E. and Pimenta, L. (2013) Radiographic and Clinical Evaluation of Cage Subsidence after Stand-Alone Lateral Interbody Fusion. Journal of Neurosurgery: Spine, 19,110-118. https://doi.org/10.3171/2013.4.SPINE12319
[9]
Kwon, A.J., Hunter, W.D., Moldavsky, M., Moldavsky, K. and Bucklen, B. (2016) Indirect Decompression and Vertebral Body Endplate Strength after Lateral Interbody Spacer Impaction: Cadaveric and Foam-Block Models. Journal of Neurosurgery: Spine, 24, 727-733. https://doi.org/10.3171/2015.10.SPINE15450
[10]
Hah, R., and Kang, H.P. (2019) Lateral and Oblique Lumbar Interbody Fusion— Current Concepts and a Review of Recent Literature. Current Reviews in Musculoskeletal Medicine, 12, 305-310. https://doi.org/10.1007/s12178-019-09562-6
[11]
Chatham, L.S., Patel, V.V., Yakacki, C.M., Carpenter, R.D. (2017) Interbody Spacer Material Properties and Design Conformity for Reducing Subsidence during Lumbar Interbody Fusion. Journal of Biomechanical Engineering, 139, Article 051005. https://doi.org/10.1115/1.4036312
[12]
Mechteld, L.A., et al. (2020) Efficacy of a Standalone Microporous Ceramic Versus Autograft in Instrumented Posterolateral Spinal Fusion: A Multicenter, Randomized, Intrapatient Controlled, Noninferiority Trial. Spine, 45, 944-951. https://doi.org/10.1097/BRS.0000000000003440
[13]
Marchi, L., Abdala, N., Oliveira, L., Amara, R., Coutinho, E. and Pimenta, L. (2013) Radiographic and Clinical Evaluation of Cage Subsidence after Stand-Alone Lateral Interbody Fusion. Journal of Neurosurgery: Spine, 19, 110-118. https://doi.org/10.3171/2013.4.SPINE12319
[14]
Hu, Z., He, D., Gao, J., et al. (2021) The Influence of Endplate Morphology on Cage Subsidence in Patients With Stand-Alone Oblique Lateral Lumbar Interbody Fusion (OLIF). Global Spine Journal, 13, 97-103. https://doi.org/10.1177/2192568221992098
[15]
Le, T.V., Baaj, A.A., Dakwar, E., et al. (2012) Subsidence of Polyetheretherketone Intervertebral Cages in Minimally Invasive Lateral Retroperitoneal Transpsoas Lumbar Interbody Fusion. Spine, 37, 1268-1273. https://doi.org/10.1097/BRS.0b013e3182458b2f
[16]
Kim, S.J., Lee, Y.S., Kim, Y.B., Park, S.W. and Hung, V.T. (2014) Clinical and Radiological Outcomes of a New Cage for Direct Lateral Lumbar Interbody Fusion. Korean Journal of Spine, 11, 145-151. https://doi.org/10.14245/kjs.2014.11.3.145
[17]
Alimi, M., Shin, B., Macielak, M., et al. (2015) Expandable Polyaryl-Ether-Ether-Ketone Spacers for Interbody Distraction in the Lumbar Spine. Global Spine Journal, 5, 169-178. https://doi.org/10.1055/s-0035-1552988
[18]
Zhang, Z.J., Li, H., Fogel, G.R., Liao, Z.H., Li, Y. and Liu, W.Q. (2018) Biomechanical Analysis of Porous Additive Manufactured Cages for Lateral Lumbar Interbody Fusion: A Finite Element Analysis. World Neurosurgery, 111, e581-e591. https://doi.org/10.1016/j.wneu.2017.12.127
[19]
Grant, J.P., Oxland, T.R. and Dvorak, M.F. (2001) Mapping the Structural Properties of the Lumbosacral Vertebral Endplates. Spine, 26, 889-896. https://doi.org/10.1097/00007632-200104150-00012
[20]
Krafft, P.R., Osburn, B., Vivas, A.C., Rao, G. and Alikhani, P. (2020) Novel Titanium Cages for Minimally Invasive Lateral Lumbar Interbody Fusion: First Assessment of Subsidence. Spine Surgery and Related Research, 4, 171-177. https://doi.org/10.22603/ssrr.2019-0089
[21]
van Hooff, M.L., Mannion, A.F., Staub, L.P., Ostelo, R.W.J.G. and Fairbank, J.C.T. (2016) Determination of the Oswestry Disability Index Score Equivalent to a “Satisfactory Symptom State” in Patients Undergoing Surgery for Degenerative Disorders of the Lumbar Spine—A Spine Tango Registry-Based Study. The Spine Journal, 16, 1221-1230. https://doi.org/10.1016/j.spinee.2016.06.010
[22]
Parker, R.M. and Gregory, M.M. (2017) Comparison of a Calcium Phosphate Bone Substitute with Recombinant Human Bone Morphogenetic Protein-2: A Prospective Study of Fusion Rates, Clinical Outcomes and Complications with 24-Month Follow-Up. European Spine Journal, 26, 754-763. https://doi.org/10.1007/s00586-016-4927-0
