Abstract
BackgroundRecently, Oblique lumbar interbody fusion (OLIF) is commonly indicated to correct the sagittal and coronal alignment in adult spinal deformity (ASD). Endplate fracture during surgery is a major complication of OLIF, but the detailed location of fracture in vertebral endplate in ASD has not yet been determined. We sought to determine the incidence and location of endplate fracture and subsidence of the OLIF cage in ASD surgery, and its association with fusion status and alignment.MethodsWe analyzed 75 levels in 27 patients were analyzed using multiplanar CT to detect the endplate fracture immediately after surgery and subsidence at 1 year postoperatively. The prevalence was compared between anterior and posterior, approach and non-approach sides, and concave and convex side. Their association with fusion status, local and global alignment, and complication was also investigated.ResultsEndplate fracture was observed in 64 levels (85.3%) in all 27 patients, and the incidence was significantly higher in the posterior area compared with the anterior area (85.3 vs. 68.0%, p=0.02) of affected vertebra in the sagittal plane. In the coronal plane, there was no significant difference in incidence between left (approach) and right (non-approach) sides (77.3 and 81.3%, respectively), or concave and convex sides (69.4 and 79.6%) of wedged vertebra. By contrast, cage subsidence at 1 year postoperatively was noted in 14/75 levels (18.7%), but was not associated with endplate fracture. Fusion status, local and global alignment, and complications were not associated with endplate fracture or subsidence.ConclusionEndplate fracture during OLIF procedure in ASD cases is barely avoidable, possibly induced by the corrective maneuver with ideal rod counter and cantilever force, but is less associated with subsequent cage subsidence, fusion status, and sustainment of corrected alignment in long fusion surgery performed even for elderly patients.
Highlights
A current trend in spinal fusion surgery is lateral lumbar interbody fusion (LLIF), which uses a minimally invasive lateral retroperitoneal transpsoas or anteropsoas approach to achieve interbody fusion with fewer complications [1,2,3,4]
Endplate fracture In the 75 segments that underwent Oblique lumbar interbody fusion (OLIF), endplate fracture was observed at 64 (85.3%) levels in all 27 patients
The prevalence of fracture was significantly higher in the posterior area of distal vertebrae (64.0%), than it was in the anterior area of proximal vertebra (48.0%) or distal vertebra (46.7%)
Summary
A current trend in spinal fusion surgery is lateral lumbar interbody fusion (LLIF), which uses a minimally invasive lateral retroperitoneal transpsoas or anteropsoas approach to achieve interbody fusion with fewer complications [1,2,3,4]. (OLIF) approach to lumbar discs via the space between the aorta and left-sided psoas major, avoids damage to the neural structures and psoas, and corrects sagittal and coronal alignment found in adult spinal deformity (ASD) when combined with long-level posterior spinal fusion (PSF) [5,6,7]. We used data from multiplanar computed tomography (CT) reconstruction to determine the prevalence and location of endplate fracture and subsidence after OLIF corrective surgery for ASD, and their association with intervertebral fusion at 1 year postoperatively and spinopelvic and global alignment at a mean of 47 months. Oblique lumbar interbody fusion (OLIF) is commonly indicated to correct the sagittal and coronal alignment in adult spinal deformity (ASD). We sought to determine the incidence and location of endplate fracture and subsidence of the OLIF cage in ASD surgery, and its association with fusion status and alignment
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