Abstract
BackgroundLumbar lordosis (LL) can be restored, and screw-related complications may be avoided with the stand-alone expandable cage method. However, the long-term spinopelvic changes and safety remain unknown. We aimed to elucidate the long-term radiologic outcomes and safety of this technique.MethodsData from patients who underwent multi-level stand-alone expandable cage fusion and 80 patients who underwent screw-assisted fusion between February 2007 and December 2012, with at least 5 years of follow-up, were retrospectively analyzed. Segmental angle and translation, short and whole LL, pelvic incidence, pelvic tilt, sacral slope (SS), sagittal vertical axis, thoracic kyphosis, and presence of subsidence, pseudoarthrosis, retropulsion, cage breakage, proximal junctional kyphosis (PJK), and screw malposition were assessed. The relationship between local, lumbar, and spinopelvic effects was investigated. The implant failure rate was considered a measure of procedure effectiveness and safety.ResultsIn total, 69 cases were included in the stand-alone expandable cage group and 150 cases in the control group. The stand-alone group showed shorter operative time (58.48 ± 11.10 vs 81.43 ± 13.75, P = .00028), lower rate of PJK (10.1% vs 22.5%, P = .03), and restoration of local angle (4.66 ± 3.76 vs 2.03 ± 1.16, P = .000079) than the control group. However, sagittal balance (0.01 ± 2.57 vs 0.50 ± 2.10, P = .07) was not restored, and weakness showed higher rate of subsidence (16.31% vs 4.85%, P = .0018), pseudoarthrosis (9.92% vs 2.42%, P = .02), cage, and retropulsion (3.55% vs 0, P = .01) than the control group.ConclusionsStand-alone expandable cage fusion can restore local lordosis; however, global sagittal balance was not restored. Furthermore, implant safety has not yet been proven.
Highlights
Lumbar lordosis (LL) can be restored, and screw-related complications may be avoided with the stand-alone expandable cage method
This study was conducted in accordance with the principles outlined in the Declaration of Helsinki and was approved by the institutional review board (Himchan IRB 169684-01-201906-04); written informed consent was obtained from all patients
Among 1088 cases of fusion surgery, the following inclusion criteria were applied: (1) degenerative lumbar disease symptoms present for > 2 months, (2) spinal instability confirmed on dynamic radiography but spondylolisthesis grade I or II only, and (3) involvement of at least two spinal levels
Summary
Lumbar lordosis (LL) can be restored, and screw-related complications may be avoided with the stand-alone expandable cage method. The long-term spinopelvic changes and safety remain unknown. We aimed to elucidate the long-term radiologic outcomes and safety of this technique. With the global aging society, degenerative lumbar spine disease is becoming a common health issue. Degenerative lumbar spine disease causes spinal stenosis but is related to structural and functional problems. One such problem, sagittal imbalance, is a crucial contributing factor to a decreased quality of life [1, 2]. Various approaches have been investigated to restore lumbar lordosis (LL) and sagittal balance.
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