Introduction

Cage impactions (CI) of Oblique Lumbar Interbody Fusion (OLIF) appear to be a frequent mechanical complication with a potential functional impact.

Objectives

To determine the rate of CI occurrence, their risk factors and clinical implications in the case of combined single-level arthrodesis.

Method

A retrospective analysis of prospectively collected data was performed. All our patients with degenerative spondylolisthesis initially underwent OLIF combined with pedicle screw fixation (PSF). Intraoperative control with an image intensifier and a standard radiograph in the immediate postoperative period made it possible to assess the occurrence of CI, depending on the position of the implant. Secondary subsidence was sought on the standing radiological examination using EOS biplanar radiography during follow-up. The pelvic parameters were analyzed, as well as the occurrence of bone fusion. The clinical evaluation was made at ≥ 1 year, by the Oswestry Disability Index (ODI), the walking distance (WD) and the Visual Analogue Scale (VAS).

Results

In all, 130 patients out of the 131 included were analyzed. A CI occurred in 25.3% (n = 33) of cases and of these, 94% (n = 32) occurred intraoperatively. Postmenopausal women had more CI with an odds ratio (OR) of 5.8 (P = 0.034). The “CI” group had a 9.5% lower ODI score than the “non-CI” group (P = 0.0040), but both provided excellent ODI gains of 30.8 ± 16 and 32.9 ± 15.5% (P < 0.0001). An “anterior” position of the implant allowed a greater gain in lumbar lordosis (P < 0.001) but was associated with greater CI occurrence (P < 0.001), with an OR of 6.75 (P = 0.0018).

Conclusion

The occurrence of intraoperative cage impaction is a frequent event when performing OLIF. Postmenopausal women have an approximately 6 times greater risk of impaction than men, and patients with an “anterior” implant placement have a 7 times greater risk than with central placement. The negative impact of cage impactions on the clinical score (ODI) was significant after one year of follow-up.

Level of evidence

IV, non-comparative cohort study.

中文翻译：

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单节段 OLIF 治疗退变性腰椎滑脱症中笼式嵌塞的意义

介绍

斜腰椎椎间融合术 (OLIF) 的笼式嵌塞 (CI) 似乎是一种常见的机械并发症，具有潜在的功能影响。

目标

确定联合单节段关节固定术的 CI 发生率、危险因素和临床意义。

方法

对前瞻性收集的数据进行了回顾性分析。我们所有的退行性脊柱滑脱患者最初都接受了 OLIF 联合椎弓根螺钉固定 (PSF)。使用图像增强器进行术中控制，并在术后即刻拍摄标准 X 光片，这使得根据植入物的位置评估 CI 的发生成为可能。在随访期间使用 EOS 双平面射线照相术在站立放射学检查中寻找二次沉降。分析骨盆参数，以及骨融合的发生。 在≥  1 年时，通过 Oswestry 残疾指数 (ODI)、步行距离 (WD) 和视觉模拟量表 (VAS)进行临床评估。

结果

总共分析了 131 名患者中的 130 名患者。CI 发生在 25.3% ( n  =  33) 的病例中，其中 94% ( n  =  32) 发生在术中。绝经后妇女的 CI 更高，比值比 (OR) 为 5.8 ( P  =  0.034)。“CI”组的 ODI 分数比“非 CI”组低 9.5% ( P  =  0.0040)，但两者都提供了 30.8  ±  16 和 32.9  ±  15.5% ( P  <  0.0001) 的出色 ODI 增益。植入物的“前”位允许更大程度的腰椎前凸增益（P  <  0.001），但与更大的 CI 发生相关（P  < 0.001)，OR 为 6.75 ( P  =  0.0018)。

结论

进行 OLIF 时，术中 Cage 嵌塞的发生是经常发生的事件。绝经后女性发生嵌塞的风险大约是男性的 6 倍，而采用“前路”种植体植入的患者发生嵌塞的风险是采用中央植入的患者的 7 倍。随访一年后，笼式嵌塞对临床评分 (ODI) 的负面影响显着。

证据等级

IV，非比较队列研究。