Risk factors for cage retropulsion after transforaminal lumbar interbody fusion in older patients

Abstract

BackgroundTo investigate the incidence of cage retropulsion (CR) following transforaminal lumbar interbody fusion (TLIF) and the associated risk factors in older patients with lumbar disorders.MethodsBetween January 2015 and December 2017, 1,880 older patients (aged >60 years) who underwent open TLIF were preliminarily enrolled in this retrospective study. The patients’ medical records were reviewed, and the risk factors potentially associated with CR were analyzed.ResultsA total of 1,662 patients (692 males and 970 females, with an average age of 68.7±5.2 years) who met the eligibility criteria were finally enrolled in this study. Following TLIF, 29 older patients (1.74%) developed CR including 12 patients with spinal stenosis, 7 patients with degenerative spondylolisthesis, 5 patients had degenerative disc diseases, 3 patients had surgical history, and 2 patients suffered isthmic spondylolisthesis. Of the 29 patients, 21 patients suffered lower back pain and/or sciatica (72.4%), while 8 patients were asymptomatic (27.6%). In multivariate analysis, screw loosening [odds ratio (OR) =7.315; 95% confidence interval (CI): 3.4–15.7] and endplate injury (OR =4.947; 95% CI: 2.3–10.6) were found to be independently associated with CR in older patients after TLIF.ConclusionsThe incidence of CR following TLIF in older patients is 1.74%. Screw loosening and endplate injury are risk factors for CR in older patients with TLIF.