gms | German Medical Science

German Congress of Orthopedic and Trauma Surgery (DKOU 2017)

24.10. - 27.10.2017, Berlin

Elimination of subsidence with 26mm wide cages in extreme lateral interbody fusion

Meeting Abstract

  • presenting/speaker Gernot Lang - Weill Cornell Brain and Spine Center, Weill Cornell Medicine, New York Presbyterian Hospital , New York, United States
  • Rodrigo Navarro-Ramirez - Weill Cornell Brain and Spine Center, Weill Cornell Medicine, New York Presbyterian Hospital , New York, United States
  • Ibrahim Hussain - Weill Cornell Brain and Spine Center, Weill Cornell Medicine, New York Presbyterian Hospital , New York, United States
  • Lena Gandevia - Weill Cornell Brain and Spine Center, Weill Cornell Medicine, New York Presbyterian Hospital , New York, United States
  • Connor Berlin - Weill Cornell Brain and Spine Center, Weill Cornell Medicine, New York Presbyterian Hospital , New York, United States
  • Roger Hartl - Weill Cornell Brain and Spine Center, Weill Cornell Medicine, New York Presbyterian Hospital , New York, United States

Deutscher Kongress für Orthopädie und Unfallchirurgie (DKOU 2017). Berlin, 24.-27.10.2017. Düsseldorf: German Medical Science GMS Publishing House; 2017. DocPO20-90

doi: 10.3205/17dkou747, urn:nbn:de:0183-17dkou7477

Published: October 23, 2017

© 2017 Lang et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.


Outline

Text

Objectives: Extreme lateral interbody fusion (ELIF) is utilized for indirect decompression and minimally invasive surgical treatment for various degenerative spinal disorders. However, one of the major drawbacks of ELIF is subsidence, and subsequent loss of correction. In our previous study, we found anterior posterior (AP) cage diameter to be the most important factor determining successful and sustained indirect decompression in ELIF.

The aim of the present study was to evaluate the clinical and radiographic outcome of patients undergoing ELIF in which 26mm AP diameter cages were implanted, and compared these results to those of our previous studies on 18mm and 22mm cages.

Methods: Patients undergoing ELIF between 2012 and 2016 were included in a retrospective study. Radiographic parameters including lumbar lordosis, foraminal height, and disc height as well as clinical outcome parameters (Oswestry Disability Index (ODI) and Visual Analogue Scale (VAS)) were measured preoperatively, postoperatively, and at the latest follow-up examination. Cage dimensions, in situ position and type were correlated with radiographic and clinical outcome parameters.

Results and Conclusion: 26 patients containing 28 spinal segments were analyzed. ELIF was successfully accomplished in all patients. At the last follow-up of 17.7 months, radiographical (foraminal height (Δ=+3.19 ± 0.73mm), disc height (Δ=+5.84 ± 0.61mm), and clinical outcome measures revealed significant improvement compared to before surgery. Implantation of 26mm cages eliminated postoperative subsidence to a minimum (Postoperative to follow-up of 17.7 months: foraminal height (Δ=-0.016 ± 0.57mm) and disc height (Δ= 0.52 ± 0.21mm) compared to 18mm (1.37 ± 0.29mm and 1.1 ± 0.1mm) and 22mm (1.3 ± 0.25mm and 0.8 ± 0.1mm) cages; though this finding was not yet significant. 26mm cages presented superior restoration of disc heights compared to 18mm and 22mm cages (p≤0.05) as well as a significantly higher restoration of foraminal heights compared to 18mm cages (p ≤0.05; Figure 1 [Fig. 1]). Neither position of the cage (anterior vs. posterior), nor the type (parallel vs. lordotic) had a significant impact on restoration of foraminal height and/or lumbar lordosis. Moreover, the side of surgical approach did not influence the amount of foraminal height increase.

Cage AP diameter is the determining factor in restoration of foraminal height in ELIF. Sustainable foraminal height restoration is achieved by implantation of wider cages. Based on the current findings, we recommend to use the widest cages possible in order to reduce the risk for postoperative subsidence following ELIF.