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| ZHOU Qingshuang,CHEN Xi,LI Song.Cage subsidence after monosegmental transforaminal lumbar interbody fusion at the lower lumbar spine: its effect on sagittal alignment[J].Chinese Journal of Spine and Spinal Cord,2019,(6):536-543. |
| Cage subsidence after monosegmental transforaminal lumbar interbody fusion at the lower lumbar spine: its effect on sagittal alignment |
| Received:March 03, 2019 Revised:May 25, 2019 |
| English Keywords:Monosegmental Transforaminal lumbar interbody fusion Cage subsidence Lumbar sagittal alignment |
| Fund:国家自然科学基金（项目编号：81772422）；江苏省科技发展计划项目（项目编号：BE2017606） |
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| English Abstract: |
| 【Abstract】 Objectives: To investigate the effects of cage subsidence after monosegmental transforaminal lumbar interbody fusion(TLIF) at the lower lumbar spine on the sagittal alignment outcomes. Methods: A consecutive cohort of 114 patients(31 males and 83 females) was retrospectively reviewed, who had received monosegmental TLIF at L4/5 or L5/S1 level between January 2015 and January 2017, with an average age of 57.0±11.6 years(31-74 years) and a mean follow-up of 29.8±4.3 months. There were 65 patients receiving TLIF at L4/5 and 49 at L5/S1. They were also classified into the cage subsidence group and the non-subsidence group, with 22 patients in the cage subsidence group and 92 patients in the non-subsidence group, respectively. Lumbar lordosis(LL), segmental lordosis(SL) and disc height(DH) parameters were measured to evaluate the radiographic outcomes. The 3 months after postoperative parameters minus its values in preoperation and the final follow-up values minus the values in 3 months after postoperative represented reconstruction and the loss of follow-up respectively. Oswestry disability index(ODI) and visual analogue scale(VAS) were collected to evaluate the clinical outcomes. The student T test was used to compare continuous variables and chi-squared test for categorical variables(P<0.05 was considered statistically significant). Results: There was no statistical significance in preoperative, postoperative and final follow-up LL, SL or DH between the L4/5 group and the L5/S1 group(P>0.05). However, the reconstruction of LL and SL in the L4/5 group were superior than those in the L5/S1 group(4.8°±1.0° vs 3.2°±0.96°, P<0.001). Also, patients in the L5/S1 group were noted to have more significant loss in LL and SL(2.7°±0.5° vs -0.15°±0.79°, P<0.001). In addition, there was no significant difference in reconstruction or loss of DH between two groups(P>0.05). The incidence of cage subsidence in this study was 19.4%, being a little higher at L5/S1 than L4/5(15.4% vs 24.5%) but without statistical significance(P>0.05). The age in the cage subsidence group was older than the non-subsidence group(P<0.05). There was no statistical significance of reconstructive LL, SL and DH between the cage subsidence group and the non-subsidence group at preoperation, postoperation and the final follow-up(P>0.05). However, the losses of LL, SL and DH in the cage subsidence group were higher than those in the non-subsidence group at the final follow-up(P<0.05), but the patient reported outcomes were not significantly different between two groups with/without cage subsidence before surgery or at each follow-up(P>0.05). Conclusions: About 19.3% of patients experienced cage subsidence after monosegmental TLIF at the lower lumbar spine, slightly more frequently at L5/S1 than L4/5. Cage subsidence had a significant association with correction loss of SL and LL, but it did not affect patient reported outcomes. |
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