#322 Interbody Cages with Wide Contact Area in Lateral Interbody Fusion – Clinical Experience
MIS Techniques and Outcomes
Poster Presented by: R. Amaral
R. Amaral (1)
T. Coutinho (1)
L. Marchi (1)
L. Oliveira (1)
T. Bueno (1)
R. Jensen (1)
E. Coutinho (1)
L. Pimenta (1,2)
(1) IPC, Sao Paulo, Brazil
(2) UCSD San Diego, Neurosurgery, San Diego, CA, United States
Biomechanical studies have revealed that lumbar interbody constructions with wide footprint cages have great mechanical stability. The clinical influences of the cage width on indexes of surgical goals and complications is yet unknown on lateral interbody fusion.
Prospective, non-randomized single-center study with subjects undergoing XLIF with 26mm-wide cages. Patients enrolled presented conditions as DDD with stenosis, ASD, FBS, low grade spondylolisthesis, degenerative scoliosis (Lenke-Silva II and III), pseudoarthrosis and failed TDR. Minimum follow-up - 3 months (up to 24 months). VAS back/leg pain, ODI and EQ-5D questionnaires were used. Complications were recorded.
127 patients (61 years, 25-85; 55% F) and 186 lumbar spine levels (54% L4L5) Mean lateral access duration was 96 minutes. 28 cases (22%) received supplementation; 78% standalone. Supplementation was added for instable cases or in result of unwanted intraoperative ALL/anterior annulus violation (5 in 186 levels - 3%). There were no wound infections, no vascular injuries, and no intraoperative visceral injuries. 22 levels (13%) experienced high-grade (grade II/III) cage subsidence, but only 4 resulted in restenosis. All subsidence cases were standalone constructions and had some associated risk factor (unidentified instability, unintentional ALL violation, osteoporosis or partially blocked facets). 12 needed reoperation (9%) - 4 cases -subsidence and consequent instability or restenosis; 4 cases -indirect decompression was not sufficient; 2 for adjacent stenosis; psoas hematoma case (1%); painful cage micromotion (1%); screw malpositioning (1%). No case showed femoral nerve lesion or muscle (psoas or quadriceps) atrophy, although transient access-related side effects were observed - hip flexion weakness and numbness in ipsilateral limb. Clinical outcomes were seen to improve compared to baseline.
Wider cages are biomechanically stable and have a significant impact on avoiding cage subsidence occurrence, while was not observed increment on complications. So, there is the possibility to have standalone as a quick and less morbidity surgery as an option for surgeons and elderly or clinical restricted patients.