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Multilevel Oblique Lumbar Interbody Fusion in Degenerative Lumbar Disc Disease with Instability
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Risk factors for polyetheretherketone cage subsidence following minimally invasive transforaminal lumbar interbody
Weerasak Singhatanadgige1,2, Amnat Sukthuayat1, Terdpong Tanaviriyachai3
1Department of Orthopedics, Faculty of Medicine, Chulalongkorn University, 1873 Rama IV Rd, Pathumwan, Bangkok, 10330, Thailand.
Background:
Interbody cage subsidence is a postoperative complication leading to poor outcomes after minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF). This study aimed to identify risk factors of cage subsidence in lumbar spinal diseases after MIS-TLIF using polyetheretherketone (PEEK) cage.
Methods:
In this retrospective cohort study, plain radiographs and three-dimensional computed tomography (3D-CT) performed 12 months after MIS-TLIF were evaluated, and the risk of cage subsidence was calculated with odds ratio (OR), confidence interval (CI), and logistic regression analysis.
Results:
A total of 114 patients (mean age, 65 years) and 135 levels were included in this study: 80 (59.3%) with and 55 (40.7%) without cage subsidence. Multifidus atrophy showed the strongest association with PEEK cage subsidence (p < 0.001). Compared to those with normal mass, the odds of PEEK cage subsidence were 76.0 (95% CI: 3.9-1472.9) for severe atrophy. The factors significantly associated with cage subsistence were posterior cage position (OR = 4.2; p = 0.005), cage height ≥ 12 mm (OR = 7.6; p = 0.008), use of an autograft mixed with demineralized bone matrix (DBM) (OR = 5.8; p = 0.002), body mass index (BMI) > 27.5 kg/m2 (OR = 4.2; p = 0.03), and titanium-coated PEEK (Ti-PEEK) cage-type (OR = 38.4, p = 0.02).
Conclusions:
In MIS-TLIF with a PEEK cage, the factors associated with an increased risk of cage subsidence were higher BMI, increased severity of multifidus muscle atrophy, Ti-coated PEEK cage-type, cage height ≥ 12 mm, use of DBM mixed autograft, and posterior cage position.
Insights
Minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) with polyetheretherketone (PEEK) cages carries risks of subsidence. Factors like multifidus atrophy, posterior cage placement, and higher BMI increase this risk.
Area of Science:
- Spine Surgery
- Orthopedic Surgery
- Biomaterials in Medicine
Background:
- Interbody cage subsidence is a significant postoperative complication following minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF).
- This complication can lead to adverse patient outcomes after spinal fusion procedures.
- Polyetheretherketone (PEEK) cages are commonly used in MIS-TLIF, and understanding their subsidence risk is crucial.
Purpose of the Study:
- To identify and analyze the risk factors associated with interbody cage subsidence in patients undergoing MIS-TLIF using PEEK cages.
- To quantify the association between various patient and surgical factors and the incidence of PEEK cage subsidence.
- To provide insights for improving surgical techniques and patient selection to minimize subsidence.
Main Methods:
- A retrospective cohort study design was employed, analyzing data from 114 patients (135 levels) who underwent MIS-TLIF with PEEK cages.
- Plain radiographs and 3D-CT scans were evaluated at 12 months post-surgery to assess cage subsidence.
- Logistic regression analysis, odds ratios (OR), and confidence intervals (CI) were used to determine the statistical significance of identified risk factors.
Main Results:
- Cage subsidence was observed in 59.3% of the studied levels.
- Severe multifidus atrophy demonstrated the strongest association with PEEK cage subsidence (OR=76.0).
- Other significant risk factors included posterior cage position (OR=4.2), cage height ≥ 12 mm (OR=7.6), use of DBM mixed autograft (OR=5.8), BMI > 27.5 kg/m² (OR=4.2), and titanium-coated PEEK (Ti-PEEK) cages (OR=38.4).
Conclusions:
- Higher BMI, severe multifidus muscle atrophy, posterior cage positioning, larger cage height (≥ 12 mm), use of DBM mixed autograft, and Ti-coated PEEK cages are significant risk factors for subsidence in MIS-TLIF.
- These findings highlight the importance of considering patient factors and surgical technique when using PEEK cages to mitigate subsidence risk.
- Further research may focus on developing strategies to prevent or reduce cage subsidence in MIS-TLIF procedures.
