Risk factors for cage retropulsion after posterior lumbar interbody fusion: analysis of 1070 cases.
Summary of "Risk factors for cage retropulsion after posterior lumbar interbody fusion: analysis of 1070 cases."
STUDY DESIGN.: Single-center retrospective study. OBJECTIVE.: We examined the risk factors for cage retropulsion after posterior lumbar interbody fusion (PLIF) performed for patients with degenerative lumbar spinal diseases. SUMMARY OF BACKGROUND DATA.: Although PLIF is a widely accepted procedure, problems remain regarding perioperative and postoperative complications. There are few reported studies identifying specific risk factors for cage retropulsion, one of the implant-related complications after PLIF, although several case reports have been published. METHODS.: Between April 2006 and July 2010, 1070 patients with various degenerative lumbar spinal diseases underwent single- or multilevel PLIF combined with posterolateral fusion, using posterior pedicle screw fixation and box-type cages. Their medical records and preoperative radiographs were reviewed and the factors influencing the incidence of cage retropulsion were analyzed. RESULTS.: There were 9 cases of cage retropulsion (7 men and 2 women; mean age, 68.2 yr), and it developed within 2 months after surgery in all cases. Five patients had low back pain or leg pain, 3 of whom required revision surgery. The mean fusion level was 3.9 (range, 2-5); in 6 of the 9 patients, the cage had migrated at L5/S, 2 at L4/5, and 1 at L3/4. All of the cages were inserted at the end disc level of multilevel fusion procedures. The disc heights and ranges of motion were significantly greater in patients with cage retropulsion, and patients with a pear-shaped disc space also showed a higher rate of cage retropulsion. CONCLUSION.: These results indicate that PLIF at L5/S, a wide disc space with instability, multilevel fusion surgery, and a pear-shaped disc space on lateral radiographs are risk factors for cage retropulsion. The identification of these risk factors should allow us to avoid this complication, and the use of expandable cages is an effective option for such cases.
Affiliation
From the Department of Orthopedic Surgery, Gakkentoshi Hospital, Kyoto, Japan.
Journal Details
This article was published in the following journal.
Name: Spine
ISSN: 1528-1159
Pages: 1164-9
Links
- PubMed Source: http://www.ncbi.nlm.nih.gov/pubmed/22647991
- DOI: http://dx.doi.org/10.1097/BRS.0b013e318257f12a
Medical and Biotech [MESH] Definitions
Causality
The relating of causes to the effects they produce. Causes are termed necessary when they must always precede an effect and sufficient when they initiate or produce an effect. Any of several factors may be associated with the potential disease causation or outcome, including predisposing factors, enabling factors, precipitating factors, reinforcing factors, and risk factors.
Confounding Factors (epidemiology)
Factors that can cause or prevent the outcome of interest, are not intermediate variables, and are not associated with the factor(s) under investigation. They give rise to situations in which the effects of two processes are not separated, or the contribution of causal factors cannot be separated, or the measure of the effect of exposure or risk is distorted because of its association with other factors influencing the outcome of the study.
Spinal Puncture
Tapping of the subarachnoid space in the lumbar region, usually between the third and fourth lumbar vertebrae.
Risk Reduction Behavior
Reduction of high-risk choices and adoption of low-risk quantity and frequency alternatives.
Hypothalamus, Posterior
The part of the hypothalamus posterior to the middle region consisting of several nuclei including the medial mamillary nucleus, lateral mamillary nucleus, and posterior hypothalamic nucleus (posterior hypothalamic area). The posterior hypothalamic area is concerned with control of sympathetic responses and is sensitive to conditions of decreasing temperature and controls the mechanisms for the conservation and increased production of heat.
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