Cargando…

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...

Descripción completa

Detalles Bibliográficos
Autores principales: Ebata, Shigeto, Ohba, Tetsuro, Haro, Hirotaka
Formato: Online Artículo Texto
Lenguaje:English
Publicado: The Japanese Society for Spine Surgery and Related Research 2018
Materias:
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
_version_ 1783444563098075136
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
work_keys_str_mv AT ebatashigeto adequatecageplacementforasatisfactoryoutcomeafterlumbarlateralinterbodyfusionwithmriandctanalysis
AT ohbatetsuro adequatecageplacementforasatisfactoryoutcomeafterlumbarlateralinterbodyfusionwithmriandctanalysis
AT harohirotaka adequatecageplacementforasatisfactoryoutcomeafterlumbarlateralinterbodyfusionwithmriandctanalysis