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Adequate cage placement for a satisfactory outcome after lumbar lateral interbody fusion with MRI and CT analysis
INTRODUCTION: Through an extreme lateral retroperitoneal and transpsoas approach to intervertebral disc and fusion surgery, a large lordosis cage can be placed for solid and stable intervertebral fusion and to provide strong anterior support, disc height restoration, favorable alignment, and indirec...
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
The Japanese Society for Spine Surgery and Related Research
2018
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Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6698541/ https://www.ncbi.nlm.nih.gov/pubmed/31440647 http://dx.doi.org/10.22603/ssrr.2017-0037 |
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author | Ebata, Shigeto Ohba, Tetsuro Haro, Hirotaka |
author_facet | Ebata, Shigeto Ohba, Tetsuro Haro, Hirotaka |
author_sort | Ebata, Shigeto |
collection | PubMed |
description | INTRODUCTION: Through an extreme lateral retroperitoneal and transpsoas approach to intervertebral disc and fusion surgery, a large lordosis cage can be placed for solid and stable intervertebral fusion and to provide strong anterior support, disc height restoration, favorable alignment, and indirect nerve decompression. However, appropriate placement of the interbody cage remains insufficiently researched. We sought to determine both appropriate cage placement as well as other factors affecting nerve decompression in extreme lateral interbody fusion (XLIF) surgery. METHODS: We included 53 consecutive patients suffering from lumbar degenerative diseases with an indication for XLIF. Radiographic analysis using a sagittal computed tomography (CT) and axial magnetic resonance imaging (MRI) views was conducted to determine intervertebral disc height and angle, degree of disc bulging and thickness of the flavum, the area of the dural tube, cage height, pre- and postoperative disc bulging, change of disc bulging after surgery, cage subsidence, and cage placement at the rostral and caudal endplates. RESULTS: Intervertebral disc height and angle were significantly increased at all levels (L2/3, 3/4, 4/5) (p < 0.05). The area of the dural tube was significantly increased (p < 0.05), whereas the degree of disc bulging and thickness of the flavum were significantly decreased at all disc levels (p < 0.05). The enlarged area of the dural tube showed significant correlation with increased disc height (p = 0.019), preoperative flavum thickness (p = 0.008), change of flavum thickness (p < 0.0001), and cage placement at the rostral endplate (p = 0.014). CONCLUSIONS: A decrease in flavum buckling is more important than disc protrusion as a consideration for obtaining indirect decompression. Central placement may be advantageous for indirect decompression. |
format | Online Article Text |
id | pubmed-6698541 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2018 |
publisher | The Japanese Society for Spine Surgery and Related Research |
record_format | MEDLINE/PubMed |
spelling | pubmed-66985412019-08-22 Adequate cage placement for a satisfactory outcome after lumbar lateral interbody fusion with MRI and CT analysis Ebata, Shigeto Ohba, Tetsuro Haro, Hirotaka Spine Surg Relat Res Original Article INTRODUCTION: Through an extreme lateral retroperitoneal and transpsoas approach to intervertebral disc and fusion surgery, a large lordosis cage can be placed for solid and stable intervertebral fusion and to provide strong anterior support, disc height restoration, favorable alignment, and indirect nerve decompression. However, appropriate placement of the interbody cage remains insufficiently researched. We sought to determine both appropriate cage placement as well as other factors affecting nerve decompression in extreme lateral interbody fusion (XLIF) surgery. METHODS: We included 53 consecutive patients suffering from lumbar degenerative diseases with an indication for XLIF. Radiographic analysis using a sagittal computed tomography (CT) and axial magnetic resonance imaging (MRI) views was conducted to determine intervertebral disc height and angle, degree of disc bulging and thickness of the flavum, the area of the dural tube, cage height, pre- and postoperative disc bulging, change of disc bulging after surgery, cage subsidence, and cage placement at the rostral and caudal endplates. RESULTS: Intervertebral disc height and angle were significantly increased at all levels (L2/3, 3/4, 4/5) (p < 0.05). The area of the dural tube was significantly increased (p < 0.05), whereas the degree of disc bulging and thickness of the flavum were significantly decreased at all disc levels (p < 0.05). The enlarged area of the dural tube showed significant correlation with increased disc height (p = 0.019), preoperative flavum thickness (p = 0.008), change of flavum thickness (p < 0.0001), and cage placement at the rostral endplate (p = 0.014). CONCLUSIONS: A decrease in flavum buckling is more important than disc protrusion as a consideration for obtaining indirect decompression. Central placement may be advantageous for indirect decompression. The Japanese Society for Spine Surgery and Related Research 2018-01-27 /pmc/articles/PMC6698541/ /pubmed/31440647 http://dx.doi.org/10.22603/ssrr.2017-0037 Text en Copyright © 2018 by The Japanese Society for Spine Surgery and Related Research https://creativecommons.org/licenses/by-nc-nd/4.0/ Spine Surgery and Related Research is an Open Access journal distributed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License. To view the details of this license, please visit (https://creativecommons.org/licenses/by-nc-nd/4.0/). |
spellingShingle | Original Article Ebata, Shigeto Ohba, Tetsuro Haro, Hirotaka Adequate cage placement for a satisfactory outcome after lumbar lateral interbody fusion with MRI and CT analysis |
title | Adequate cage placement for a satisfactory outcome after lumbar lateral interbody fusion with MRI and CT analysis |
title_full | Adequate cage placement for a satisfactory outcome after lumbar lateral interbody fusion with MRI and CT analysis |
title_fullStr | Adequate cage placement for a satisfactory outcome after lumbar lateral interbody fusion with MRI and CT analysis |
title_full_unstemmed | Adequate cage placement for a satisfactory outcome after lumbar lateral interbody fusion with MRI and CT analysis |
title_short | Adequate cage placement for a satisfactory outcome after lumbar lateral interbody fusion with MRI and CT analysis |
title_sort | adequate cage placement for a satisfactory outcome after lumbar lateral interbody fusion with mri and ct analysis |
topic | Original Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6698541/ https://www.ncbi.nlm.nih.gov/pubmed/31440647 http://dx.doi.org/10.22603/ssrr.2017-0037 |
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