Relationship between different types of interbody fusion cage and vertebral endplate injury in oblique lateral lumbar interbody fusion

doi:10.3969/j.issn.2095-4344.1933

Abstract

Abstract:

BACKGROUND: The characteristics of oblique lateral lumbar interbody fusion are large interbody fusion cage, large bone contact surface and large bone grafting window, leading to strong intervertebral stability, low risk of subsidence, and high intervertebral fusion rate. These advantages make this procedure popular in the clinic. At present, there is no specific report regarding the effects of the relationship between different types of interbody fusion cage and vertebral endplate injury in oblique lateral lumbar interbody fusion on postoperative imaging.

OBJECTIVE: To investigate the relationship between different types of interbody fusion cage and vertebral endplate injury in oblique lateral lumbar interbody fusion as well as its effect on postoperative imaging, which can help select the model of clinical cages.

METHODS: A retrospective analysis of 49 patients undergoing oblique lateral lumbar interbody fusion in a single segment from January 2018 to January 2019 was performed. All patients provided written informed consent and this study was approved by the Medical Ethics Committee of Guangdong Provincial People’s Hospital. Patient’s imaging data and clinical data were collected and the relationship between intervertebral cages of different heights, widths and lengths with vertebral endplate injuries of surgical segments was analyzed. The effects of intervertebral cages of different heights, widths and lengths on intervertebral space height and intervertebral posterior margin height were analyzed and the effects of the relationship on postoperative imaging were evaluated. The effects of endplate injury on Visual Analogue Scale and Oswestry Disability Index were analyzed, and the clinical effects were evaluated.

RESULTS AND CONCLUSION: In the oblique lateral lumbar interbody fusion, the height of the interbody cage used in the endplate injury was significantly higher than that in the non-injured, suggesting that the height of the interbody cage was related to endplate injury (P < 0.05). The 22 mm wide interbody cage was more ideal than the 18 mm wide one in intervertebral posterior margin height distraction, suggesting that the wider interbody cage had better postoperative imaging efficacy (P < 0.05). There was no significant correlation between the length and width of the interbody cage with intraoperative endplate injury, and the difference was not statistically significant (P > 0.05). The height and length of the interbody cage had no significant effect on the vertebral space height and the intervertebral posterior margin height (P > 0.05). The endplate injury had no significant effect on the Visual Analogue Scale and Oswestry Disability Index scores (P > 0.05). 81.8% of endplate injuries occurred in the upper endplate of the lower vertebral body. These results show that the higher the height of the interbody cage, the easier the endplate is injured and more common in the upper endplate. The wider the cage to open the posterior margin of the intervertebral space is more advantageous. Two important parameters, height and width, should be taken into account in the selection of the interbody fusion cage.

Key words: endplate injury, interbody fusion cage, height of posterior margin of intervertebral space, height of intervertebral space, width, height, length, interbody fusion

CLC Number:

R459.9','1');return false;" target="_blank">
R459.9

R318

R68

Cite this article

Zheng Xiaoqing, Yin Dong, Gu Honglin, Liang Guoyan, Chang Yunbing. Relationship between different types of interbody fusion cage and vertebral endplate injury in oblique lateral lumbar interbody fusion[J]. Chinese Journal of Tissue Engineering Research, 2019, 23(34): 5418-5424.

share this article

0
/ / Recommend

Add to citation manager EndNote|Reference Manager|ProCite|BibTeX|RefWorks

URL: https://www.cjter.com/EN/10.3969/j.issn.2095-4344.1933

https://www.cjter.com/EN/Y2019/V23/I34/5418

Figures/Tables 6

2.1 参与者数量分析  所有患者均顺利完成手术，所有的观察指标均在术后3 d内检测完成，全部进入结果分析，无脱落。 2.2 试验流程图  见图2。"

2.3 一般资料比较  相比术前，术后平均椎间隙高度、椎间隙后缘高度明显增加，差异有显著性意义(P < 0.05)；术后目测类比评分、ODI明显改善，差异有显著性意义(P < 0.05)；椎间隙撑开高度为(3.7±1.7) mm，椎间隙后缘撑开(2.6±1.9) mm，见表3；49例患者中有11例出现终板损伤，3例出上下终板均损伤，总的终板损伤数为14个。"

2.4 不同型号融合器与终板损伤的关系  出现终板损伤者所用椎间融合器高度显著高于无损伤者，差异有显著性意义(P < 0.05)，见表4；融合器的长度及宽度与术中终板损伤无明显相关性，差异无显著性意义(P > 0.05)，见表5，6。81.8%的终板损伤发生在下位椎体的上终板。"

2.5 终板损伤对术后影像学、临床效果的影响和骨密度的关系与无终板损伤对比，出现终板损伤对椎间隙撑开高度、椎间隙后缘撑开高度、目测类比评分、ODI无明显影响(P > 0.05)，见表4；有无骨质疏松症和术中终板损伤无明显相关性(P > 0.05)，见表7。"

2.6 不同型号融合器与术后影像学效果的关系  与使用18 mm宽度融合器相比，使用22 mm宽度融合器者的椎间隙后缘撑开更理想，差异有显著性意义(P < 0.05)；融合器的高度、长度对椎间隙高度和椎间隙后缘撑开无明显影响，差异无显著性意义(P > 0.05)，见表8。"

2.7 并发症及内植物不良反应  2例患者出现交感神经链损伤，均为使用22 mm融合器的患者，术后3个月内恢复正常。所有的病例均未出现股四头肌无力、神经根、马尾神经、血管、输尿管等损伤，伤口均一期愈合；在终板损伤的病例中，1例患者术中附加了后方单纯开窗减压。 2.8 植入物与宿主的生物相容性  用于斜向腰椎椎间治疗的聚醚醚酮材质融合器生物相容性良好，患者均未出现植入物周围感染、过敏反应、免疫反应及排斥反应等。 2.9 经典病例及融合器  见图3，4。"

References

[1]Mayer HM. A new microsurgical technique for minimally invasive anterior lumbar interbody fusion. Spine (Phila Pa 1976).1997;22(6):691-699,700.

[2]Silvestre C, Mac-Thiong JM, Hilmi R, et al. Complications and morbidities of mini-open anterior retroperitoneal lumbar interbody fusion: oblique lumbar interbody fusion in 179 patients. Asian Spine J. 2012;6(2):89-97.

[3]张建锋,范顺武,方向前,等.斜外侧椎间融合术在单节段腰椎间盘退行性疾病中的应用[J].中华骨科杂志,2017,37(2):80-88.

[4]刘进平,冯海龙.斜外侧入路腰椎间融合术在腰椎退行性疾病中的应用[J].中华神经外科杂志,2016,32(9):918-922.

[5]Abe K, Orita S, Mannoji C, et al. Perioperative complications in 155 patients who underwent oblique lateral interbody fusion surgery: perspectives and indications from a retrospective, multicenter survey. Spine (Phila Pa 1976). 2017;42(1):55-62.

[6]Fujibayashi S, Hynes RA, Otsuki B, et al. Effect of indirect neural decompression through oblique lateral interbody fusion for degenerative lumbar disease. Spine(Phila Pa 1976).2015; 40(3):E175-E182.

[7]Ohtori S, Orita S, Yamauchi K, et al. Change of lumbar ligamentum flavum after indirect decompression using anterior lumbar interbody fusion. Asian Spine J. 2017;11(1):105-112.

[8]Oliveira L, Marchi L, Coutinho E, et al. A radiographic assessment of the ability of the extreme lateral interbody fusion procedure to indirectly decompress the neural elements. Spine (Phila Pa 1976). 2010;35(26 Suppl):S331-S337.

[9]丁凌志,范顺武,胡志军,等. 斜外侧腰椎椎间融合术间接减压治疗退行性腰椎管狭窄症[J].中华骨科杂志, 2017,37(16):965-971.

[10]范顺武,胡志军.如何严格把握适应证,发挥最大技术优势——斜外侧腰椎椎间融合术临床应用的思考与体会[J].中华骨科杂志,2017, 37(16):961-964.

[11]Le TV, Baaj AA, Dakwar E, et al. Subsidence of polyetheretherketone intervertebral cages in minimally invasive lateral retroperitoneal transpsoas lumbar interbody fusion. Spine (Phila Pa 1976). 2012;37(14):1268-1273.

[12]原发性骨质疏松症诊疗指南(2017)[J].中华骨质疏松和骨矿盐疾病杂志,2017,10(5):413-444.

[13]Cloward RB. The treatment of ruptured lumbar intervertebral discs by vertebral body fusion. I. Indications, operative technique, after care. J Neurosurg.1953;10(2):154-168.

[14]Matge G. Anterior interbody fusion with the BAK-cage in cervical spondylosis. Acta Neurochir (Wien).1998;140(1):1-8.

[15]Soriano-Baron H, Newcomb A, Malhotra D, et al. Biomechanical Effects of an Oblique Lumbar PEEK Cage and Posterior Augmentation. World Neurosurg, 2019.

[16]Weiner BK, Fraser RD. Spine update lumbar interbody cages. Spine (Phila Pa 1976). 1998;23(5):634-640.

[17]钟华璋,田大胜,周云,等.斜外侧椎间融合技术的研究进展[J].中华骨科杂志,2018,38(1):46-52.

[18]郑召民,章健,刘辉,等.微创小切口侧前方腰椎间融合术治疗腰椎退变性疾病的近期疗效和围手术期并发症[J].中国脊柱脊髓杂志, 2018,28(5):410-417.

[19]Nemani VM, Aichmair A, Taher F, et al. Rate of revision surgery after stand-alone lateral lumbar interbody fusion for lumbar spinal stenosis. Spine (Phila Pa 1976). 2014;39(5):E326-E331.

[20]Closkey RF, Parsons JR, Lee CK, et al. Mechanics of interbody spinal fusion. Analysis of critical bone graft area. Spine (Phila Pa 1976). 1993;18(8):1011-1015.

[21]Tohmeh AG, Khorsand D, Watson B, et al. Radiographical and clinical evaluation of extreme lateral interbody fusion: effects of cage size and instrumentation type with a minimum of 1-year follow-up. Spine (Phila Pa 1976). 2014;39(26):E1582-E1591.

[22]Kozak JA, Heilman AE, O'Brien JP. Anterior lumbar fusion options. Technique and graft materials. Clin Orthop Relat Res. 1994;(300):45-51.

[23]Marchi L, Abdala N, Oliveira L, et al. Radiographic and clinical evaluation of cage subsidence after stand-alone lateral interbody fusion. J Neurosurg Spine. 2013;19(1):110-118.

[24]Lang G, Navarro-Ramirez R, Gandevia L, et al. Elimination of subsidence with 26-mm-wide cages in extreme lateral interbody fusion. World Neurosurg. 2017;104:644-652.

[25]Grant JP, Oxland TR, Dvorak MF. Mapping the structural properties of the lumbosacral vertebral endplates. Spine (Phila Pa 1976). 2001;26(8):889-896.

[26]Tempel ZJ, Gandhoke GS, Okonkwo DO, et al. Impaired bone mineral density as a predictor of graft subsidence following minimally invasive transpsoas lateral lumbar interbody fusion. Eur Spine J. 2015;24 Suppl 3:414-419.

[27]沈俊宏,王建,刘超,等. 斜外侧腰椎间融合术治疗退变性腰椎疾病的并发症和早期临床结果[J].中国脊柱脊髓杂志, 2018,28(5): 397-404.

[28]Kim SJ, Lee YS, Kim YB, et al. Clinical and radiological outcomes of a new cage for direct lateral lumbar interbody fusion. Korean J Spine. 2014;11(3):145-151.

[29]Anderson PA, Polly DW, Binkley NC, et al. Clinical Use of Opportunistic Computed Tomography Screening for Osteoporosis. J Bone Joint Surg Am. 2018;100(23):2073-2081.

[30]Gilbert SG, Johns PC, Chow DC, et al. Relation of vertebral bone screw axial pullout strength to quantitative computed tomographic trabecular bone mineral content. J Spinal Disord. 1993;6(6):513-521.

[31]Roberts S, McCall IW, Menage J, et al. Does the thickness of the vertebral subchondral bone reflect the composition of the intervertebral disc? Eur Spine J. 1997;6(6):385-389.

[32]Jayasinghe JA, Jones SJ, Boyde A. Three-dimensional photographic study of cancellous bone in human fourth lumbar vertebral bodies. Anat Embryol (Berl). 1994;189(3):259-274.

[33]Sato J, Ohtori S, Orita S, et al. Radiographic evaluation of indirect decompression of mini-open anterior retroperitoneal lumbar interbody fusion: oblique lateral interbody fusion for degenerated lumbar spondylolisthesis. Eur Spine J. 2017;26(3):671-678.

[34]Alimi M, Lang G, Navarro-Ramirez R, et al. The Impact of Cage Dimensions, Positioning, and Side of Approach in Extreme Lateral Interbody Fusion. Clin Spine Surg. 2018;31(1):E42-E49.

Related Articles 15

[1] Yao Rubin, Wang Shiyong, Yang Kaishun. Minimally invasive transforaminal lumbar interbody fusion for treatment of single-segment lumbar spinal stenosis improves lumbar-pelvic balance [J]. Chinese Journal of Tissue Engineering Research, 2021, 25(9): 1387-1392.

[2] Liu Zhengpeng, Wang Yahui, Zhang Yilong, Ming Ying, Sun Zhijie, Sun He. Application of 3D printed interbody fusion cage for cervical spondylosis of spinal cord type: half-year follow-up of recovery of cervical curvature and intervertebral height [J]. Chinese Journal of Tissue Engineering Research, 2021, 25(6): 849-853.

[3] Liang Yan, Zhao Yongfei, Zhu Zhenqi, Liu Haiying, Mao Keya. Minimally invasive transforaminal lumbar interbody fusion in the treatment of sciatic scoliosis caused by lumbar disc herniation: a 2-year follow-up of coronal and sagittal balance [J]. Chinese Journal of Tissue Engineering Research, 2021, 25(3): 409-413.

[4] Chen Chaofeng, Shi Yuxiong, Liang Jincheng, He Zhijun, He Dadong. Prediction algorithm of hospitalization duration after total knee arthroplasty based on machine learning [J]. Chinese Journal of Tissue Engineering Research, 2021, 25(27): 4300-4306.

[5] Lu Yiqing, He Bin, Wang Boyao, Qin Hu, Fan Lei, Wang Yunhua. Application of SLR-PLUS biological lengthened revision stem in the revision of aseptic loosening of femoral prosthesis [J]. Chinese Journal of Tissue Engineering Research, 2021, 25(27): 4318-4321.

[6] Qian Xuankun, Huang Hefei, Wu Chengcong, Liu Keting, Ou Hua, Zhang Jinpeng, Ren Jing, Wan Jianshan. Computer-assisted navigation combined with minimally invasive transforaminal lumbar interbody fusion for lumbar spondylolisthesis [J]. Chinese Journal of Tissue Engineering Research, 2021, 25(24): 3790-3795.

[7] Hu Jing, Xiang Yang, Ye Chuan, Han Ziji. Three-dimensional printing assisted screw placement and freehand pedicle screw fixation in the treatment of thoracolumbar fractures: 1-year follow-up [J]. Chinese Journal of Tissue Engineering Research, 2021, 25(24): 3804-3809.

[8] Jie Ke, Deng Peng, Zeng Yirong. Application and comparison of four commonly used methods for patellar height measurement [J]. Chinese Journal of Tissue Engineering Research, 2021, 25(24): 3875-3881.

[9] Feng Guancheng, Fang Jianming, Lü Haoran, Zhang Dongsheng, Wei Jiadong, Yu Bingbing. How does bone cement dispersion affect the early outcome of percutaneous vertebroplasty [J]. Chinese Journal of Tissue Engineering Research, 2021, 25(22): 3450-3457.

[10] Zhao Hongshun, A Jiancuo, Wang Deyuan, Xu Zhihua, Gao Shunhong. Factors affecting the height of early intervertebral space after lumbar interbody fusion via lateral approach [J]. Chinese Journal of Tissue Engineering Research, 2021, 25(21): 3332-3336.

[11] Li Rong, Zuo Enjun. Gingival retraction: application profiles and hot spotlights [J]. Chinese Journal of Tissue Engineering Research, 2021, 25(2): 322-328.

[12] Song Kaikai, Du Gangqiang, Li Peng, Jiang Shengyuan, Gong Zhihao, Zhang Zhiwei, Zhang Kai . Application of head-neck ratio in the treatment of femoral neck fracture in aged patients with artificial femoral head replacement [J]. Chinese Journal of Tissue Engineering Research, 2021, 25(18): 2805-2809.

[13] Sun Yiqiang, Xing Jianqiang, Li Xuecheng, Wang Xin, Tian Shenglan, Zhao Zihao, Geng Xiaopeng. Kyphoplasty versus vertebroplasty in the treatment of osteoporotic vertebral compression fracture in the elderly: a comparison of vertebral height recovery [J]. Chinese Journal of Tissue Engineering Research, 2021, 25(18): 2851-2855.

[14] Zhang Mingyan, Liu Xiangyang, Chang Lei, Chen Jing, Shen Xiongjie, Liu Bin, Peng Shuai, Zhang Chao, Wu Huanyu, Zhu Feng, Mou Haipin . Relationship between the intraoperative endplate injury and cage retropulsion after lumbar interbody fusion [J]. Chinese Journal of Tissue Engineering Research, 2021, 25(18): 2856-2862.

[15] Zhou Qi, Gao Yi, Wei Kang, Li Jun, Xu Jianda, Jiang Yang, Qu Yuxing. Total knee arthroplasty for rheumatoid arthritis: knee function and biochemical index changes [J]. Chinese Journal of Tissue Engineering Research, 2020, 24(9): 1337-1341.

Recommended Articles

Metrics

Viewed

Full text

Abstract

Comments

Relationship between different types of interbody fusion cage and vertebral endplate injury in oblique lateral lumbar interbody fusion

PDF

Knowledge

Abstract

Cite this article

share this article

Figures/Tables 6

References

Related Articles 15

Recommended Articles

Metrics

Comments

[1]	Yao Rubin, Wang Shiyong, Yang Kaishun. Minimally invasive transforaminal lumbar interbody fusion for treatment of single-segment lumbar spinal stenosis improves lumbar-pelvic balance [J]. Chinese Journal of Tissue Engineering Research, 2021, 25(9): 1387-1392.
[2]	Liu Zhengpeng, Wang Yahui, Zhang Yilong, Ming Ying, Sun Zhijie, Sun He. Application of 3D printed interbody fusion cage for cervical spondylosis of spinal cord type: half-year follow-up of recovery of cervical curvature and intervertebral height [J]. Chinese Journal of Tissue Engineering Research, 2021, 25(6): 849-853.
[3]	Liang Yan, Zhao Yongfei, Zhu Zhenqi, Liu Haiying, Mao Keya. Minimally invasive transforaminal lumbar interbody fusion in the treatment of sciatic scoliosis caused by lumbar disc herniation: a 2-year follow-up of coronal and sagittal balance [J]. Chinese Journal of Tissue Engineering Research, 2021, 25(3): 409-413.
[4]	Chen Chaofeng, Shi Yuxiong, Liang Jincheng, He Zhijun, He Dadong. Prediction algorithm of hospitalization duration after total knee arthroplasty based on machine learning [J]. Chinese Journal of Tissue Engineering Research, 2021, 25(27): 4300-4306.
[5]	Lu Yiqing, He Bin, Wang Boyao, Qin Hu, Fan Lei, Wang Yunhua. Application of SLR-PLUS biological lengthened revision stem in the revision of aseptic loosening of femoral prosthesis [J]. Chinese Journal of Tissue Engineering Research, 2021, 25(27): 4318-4321.
[6]	Qian Xuankun, Huang Hefei, Wu Chengcong, Liu Keting, Ou Hua, Zhang Jinpeng, Ren Jing, Wan Jianshan. Computer-assisted navigation combined with minimally invasive transforaminal lumbar interbody fusion for lumbar spondylolisthesis [J]. Chinese Journal of Tissue Engineering Research, 2021, 25(24): 3790-3795.
[7]	Hu Jing, Xiang Yang, Ye Chuan, Han Ziji. Three-dimensional printing assisted screw placement and freehand pedicle screw fixation in the treatment of thoracolumbar fractures: 1-year follow-up [J]. Chinese Journal of Tissue Engineering Research, 2021, 25(24): 3804-3809.
[8]	Jie Ke, Deng Peng, Zeng Yirong. Application and comparison of four commonly used methods for patellar height measurement [J]. Chinese Journal of Tissue Engineering Research, 2021, 25(24): 3875-3881.
[9]	Feng Guancheng, Fang Jianming, Lü Haoran, Zhang Dongsheng, Wei Jiadong, Yu Bingbing. How does bone cement dispersion affect the early outcome of percutaneous vertebroplasty [J]. Chinese Journal of Tissue Engineering Research, 2021, 25(22): 3450-3457.
[10]	Zhao Hongshun, A Jiancuo, Wang Deyuan, Xu Zhihua, Gao Shunhong. Factors affecting the height of early intervertebral space after lumbar interbody fusion via lateral approach [J]. Chinese Journal of Tissue Engineering Research, 2021, 25(21): 3332-3336.
[11]	Li Rong, Zuo Enjun. Gingival retraction: application profiles and hot spotlights [J]. Chinese Journal of Tissue Engineering Research, 2021, 25(2): 322-328.
[12]	Song Kaikai, Du Gangqiang, Li Peng, Jiang Shengyuan, Gong Zhihao, Zhang Zhiwei, Zhang Kai . Application of head-neck ratio in the treatment of femoral neck fracture in aged patients with artificial femoral head replacement [J]. Chinese Journal of Tissue Engineering Research, 2021, 25(18): 2805-2809.
[13]	Sun Yiqiang, Xing Jianqiang, Li Xuecheng, Wang Xin, Tian Shenglan, Zhao Zihao, Geng Xiaopeng. Kyphoplasty versus vertebroplasty in the treatment of osteoporotic vertebral compression fracture in the elderly: a comparison of vertebral height recovery [J]. Chinese Journal of Tissue Engineering Research, 2021, 25(18): 2851-2855.
[14]	Zhang Mingyan, Liu Xiangyang, Chang Lei, Chen Jing, Shen Xiongjie, Liu Bin, Peng Shuai, Zhang Chao, Wu Huanyu, Zhu Feng, Mou Haipin . Relationship between the intraoperative endplate injury and cage retropulsion after lumbar interbody fusion [J]. Chinese Journal of Tissue Engineering Research, 2021, 25(18): 2856-2862.
[15]	Zhou Qi, Gao Yi, Wei Kang, Li Jun, Xu Jianda, Jiang Yang, Qu Yuxing. Total knee arthroplasty for rheumatoid arthritis: knee function and biochemical index changes [J]. Chinese Journal of Tissue Engineering Research, 2020, 24(9): 1337-1341.