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Reverse Lumbar Pedicle Screw in Oblique Lateral Interbody Fusion: A Novel Concept to Restrict Cage Subsidence

OBJECTIVE: Cage subsidence is a common morbidity after oblique lumbar interbody fusion (OLIF), with risk of compromising clinical and radiographic outcomes. The study aims to describe an innovative reverse lumbar pedicle screw (RLPS) technique in OLIF and compare its effect on restricting cage subsi...

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Autores principales: He, Jinyue, Luo, Fei, Fang, Qing, Xu, Jianzhong, Zhang, Zehua
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley & Sons Australia, Ltd 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10694012/
https://www.ncbi.nlm.nih.gov/pubmed/37873589
http://dx.doi.org/10.1111/os.13898
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author He, Jinyue
Luo, Fei
Fang, Qing
Xu, Jianzhong
Zhang, Zehua
author_facet He, Jinyue
Luo, Fei
Fang, Qing
Xu, Jianzhong
Zhang, Zehua
author_sort He, Jinyue
collection PubMed
description OBJECTIVE: Cage subsidence is a common morbidity after oblique lumbar interbody fusion (OLIF), with risk of compromising clinical and radiographic outcomes. The study aims to describe an innovative reverse lumbar pedicle screw (RLPS) technique in OLIF and compare its effect on restricting cage subsidence with classical lateral fixation (LF) in radiological and clinical evaluation. METHOD: Consecutive patients having undergone single‐level OLIF‐LF/RLPS from 2018 to 2020 were retrospectively reviewed. In OLIF‐RLPS, the upper entry point was determined at the intersection between one horizontal line (1 cm above inferior endplate) and one vertical line (dissecting anterior and middle thirds of the vertebra) while the inferior entry point between one horizontal line (5 mm below superior endplate) and the same vertical line. Trajectories were from vertebrae reverse into contralateral pedicle. Radiological evaluation included disc height (DH) and segmental lordosis (SL); cage subsidence was evaluated by DH loss. Clinical assessment included visual analogue scale (VAS) and Oswestry disability index (ODI). Student t or Mann–Whitney U test was used for continuous variation according to normality analysis while Chi‐square test for category variation. RESULTS: A total of 29 patients had been enrolled in the study including 14 cases in the RLPS group and 15 cases in the LF group. The DH in the OLIF‐RLPS group had increased from the preoperative 9.07 ± 1.73 mm to 13.73 ± 1.83 mm postoperatively, without significant difference compared with the OLIF‐LF group during the perioperative, but decreased to 12.53 ± 1.74 mm in 3 months and maintained at 12.00 ± 1.45 mm in 12 months, significantly higher than the OLIF‐LF group (p < 0.05). At the last follow‐up, 7.1% (1/14) cases in the OLIF‐RLPS group had shown subsidence of grade I, significantly less than 46.7% (7/15) cases in the OLIF‐LF group. Pain and disability had improved similarly in two groups, without significant difference detected between two groups at the last follow‐up. CONCLUSION: RLPS technique with modified entry points and prolonged trajectory could effectively restrict cage subsidence in OLIF postoperatively compared with traditional lateral fixation.
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spelling pubmed-106940122023-12-05 Reverse Lumbar Pedicle Screw in Oblique Lateral Interbody Fusion: A Novel Concept to Restrict Cage Subsidence He, Jinyue Luo, Fei Fang, Qing Xu, Jianzhong Zhang, Zehua Orthop Surg Clinical Articles OBJECTIVE: Cage subsidence is a common morbidity after oblique lumbar interbody fusion (OLIF), with risk of compromising clinical and radiographic outcomes. The study aims to describe an innovative reverse lumbar pedicle screw (RLPS) technique in OLIF and compare its effect on restricting cage subsidence with classical lateral fixation (LF) in radiological and clinical evaluation. METHOD: Consecutive patients having undergone single‐level OLIF‐LF/RLPS from 2018 to 2020 were retrospectively reviewed. In OLIF‐RLPS, the upper entry point was determined at the intersection between one horizontal line (1 cm above inferior endplate) and one vertical line (dissecting anterior and middle thirds of the vertebra) while the inferior entry point between one horizontal line (5 mm below superior endplate) and the same vertical line. Trajectories were from vertebrae reverse into contralateral pedicle. Radiological evaluation included disc height (DH) and segmental lordosis (SL); cage subsidence was evaluated by DH loss. Clinical assessment included visual analogue scale (VAS) and Oswestry disability index (ODI). Student t or Mann–Whitney U test was used for continuous variation according to normality analysis while Chi‐square test for category variation. RESULTS: A total of 29 patients had been enrolled in the study including 14 cases in the RLPS group and 15 cases in the LF group. The DH in the OLIF‐RLPS group had increased from the preoperative 9.07 ± 1.73 mm to 13.73 ± 1.83 mm postoperatively, without significant difference compared with the OLIF‐LF group during the perioperative, but decreased to 12.53 ± 1.74 mm in 3 months and maintained at 12.00 ± 1.45 mm in 12 months, significantly higher than the OLIF‐LF group (p < 0.05). At the last follow‐up, 7.1% (1/14) cases in the OLIF‐RLPS group had shown subsidence of grade I, significantly less than 46.7% (7/15) cases in the OLIF‐LF group. Pain and disability had improved similarly in two groups, without significant difference detected between two groups at the last follow‐up. CONCLUSION: RLPS technique with modified entry points and prolonged trajectory could effectively restrict cage subsidence in OLIF postoperatively compared with traditional lateral fixation. John Wiley & Sons Australia, Ltd 2023-10-24 /pmc/articles/PMC10694012/ /pubmed/37873589 http://dx.doi.org/10.1111/os.13898 Text en © 2023 The Authors. Orthopaedic Surgery published by Tianjin Hospital and John Wiley & Sons Australia, Ltd. https://creativecommons.org/licenses/by-nc/4.0/This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.
spellingShingle Clinical Articles
He, Jinyue
Luo, Fei
Fang, Qing
Xu, Jianzhong
Zhang, Zehua
Reverse Lumbar Pedicle Screw in Oblique Lateral Interbody Fusion: A Novel Concept to Restrict Cage Subsidence
title Reverse Lumbar Pedicle Screw in Oblique Lateral Interbody Fusion: A Novel Concept to Restrict Cage Subsidence
title_full Reverse Lumbar Pedicle Screw in Oblique Lateral Interbody Fusion: A Novel Concept to Restrict Cage Subsidence
title_fullStr Reverse Lumbar Pedicle Screw in Oblique Lateral Interbody Fusion: A Novel Concept to Restrict Cage Subsidence
title_full_unstemmed Reverse Lumbar Pedicle Screw in Oblique Lateral Interbody Fusion: A Novel Concept to Restrict Cage Subsidence
title_short Reverse Lumbar Pedicle Screw in Oblique Lateral Interbody Fusion: A Novel Concept to Restrict Cage Subsidence
title_sort reverse lumbar pedicle screw in oblique lateral interbody fusion: a novel concept to restrict cage subsidence
topic Clinical Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10694012/
https://www.ncbi.nlm.nih.gov/pubmed/37873589
http://dx.doi.org/10.1111/os.13898
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