Risk factors for intraoperative endplate injury during minimally-invasive lateral lumbar interbody fusion
Abstract During lateral lumbar interbody fusion (LLIF), unintended intraoperative endplate injury (IEPI) can occur and thereafter lead cage subsidence. The aim of this study was to investigate the incidence of IEPI during LLIF, and its predisposing factors. A retrospective review was conducted on co...
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| Format: | Article |
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Nature Portfolio
2021-10-01
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| Series: | Scientific Reports |
| Online Access: | https://doi.org/10.1038/s41598-021-99751-6 |
| _version_ | 1818890765387956224 |
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| author | Young-Hoon Kim Kee-Yong Ha Ki-Tack Kim Dong-Gune Chang Hyung-Youl Park Eun-Ji Yoon Sang-Il Kim |
| author_facet | Young-Hoon Kim Kee-Yong Ha Ki-Tack Kim Dong-Gune Chang Hyung-Youl Park Eun-Ji Yoon Sang-Il Kim |
| author_sort | Young-Hoon Kim |
| collection | DOAJ |
| description | Abstract During lateral lumbar interbody fusion (LLIF), unintended intraoperative endplate injury (IEPI) can occur and thereafter lead cage subsidence. The aim of this study was to investigate the incidence of IEPI during LLIF, and its predisposing factors. A retrospective review was conducted on consecutive patients (n = 186; mean age, 70.0 ± 7.6 years) who underwent LLIF at 372 levels. Patient’s demographic and surgical data were compared between patients with and without IEPI. Also, the radiographic data of each level were compared between intact and IEPI segments. IEPI was identified at 76 levels (20.4%) in 65 patients. The incidences of IEPI at every 100 consecutive segments were not different. When 372 segments were analyzed independently, sagittal disc angle (DA) in the extended position (4.3° ± 3.6° at IEPI segments vs. 6.4° ± 4.0° at intact segments), the difference between sagittal DA in the extended position and cage angle (− 2.2° ± 4.0° vs. 0.0° ± 3.9°), and the difference between preoperative disc height and cage height (− 5.4 mm ± 2.4 mm vs. − 4.7 mm ± 2.0 mm) were different significantly. Also, endplate sclerosis was more common at intact segments than IEPI segments (33.2% vs. 17.3%). Multivariate analysis showed that male sex (odds ratio [OR] 0.160; 95% confidence interval [CI] 0.036–0.704), endplate sclerosis (OR 3.307; 95% CI 1.450–8.480), and sagittal DA in the extended position (OR 0.674; 95% CI 0.541–0.840) were significant associated factors for IEPI. IEPI was correlated not with surgeon’s experience, but with patient factors, such as sex, preoperative disc angle, and endplate sclerosis. Careful surgical procedures should be employed for patients with these predisposing factors. |
| first_indexed | 2024-12-19T17:30:07Z |
| format | Article |
| id | doaj.art-37799f281a68418287499d10ec3be337 |
| institution | Directory Open Access Journal |
| issn | 2045-2322 |
| language | English |
| last_indexed | 2024-12-19T17:30:07Z |
| publishDate | 2021-10-01 |
| publisher | Nature Portfolio |
| record_format | Article |
| series | Scientific Reports |
| spelling | doaj.art-37799f281a68418287499d10ec3be3372022-12-21T20:12:29ZengNature PortfolioScientific Reports2045-23222021-10-011111710.1038/s41598-021-99751-6Risk factors for intraoperative endplate injury during minimally-invasive lateral lumbar interbody fusionYoung-Hoon Kim0Kee-Yong Ha1Ki-Tack Kim2Dong-Gune Chang3Hyung-Youl Park4Eun-Ji Yoon5Sang-Il Kim6Department of Orthopedic Surgery, Seoul St. Mary’s Hospital, The Catholic University of KoreaDepartment of Orthopedic Surgery, Kyung-Hee University Hospital at Gangdong, Kyung-Hee UniversityDepartment of Orthopedic Surgery, Kyung-Hee University Hospital at Gangdong, Kyung-Hee UniversityDepartment of Orthopedic Surgery, Sanggye Paik Hospital, Inje UniversityDepartment of Orthopedic Surgery, Eunpyeong St. Mary’s Hospital, The Catholic University of KoreaDepartment of Orthopedic Surgery, Seoul St. Mary’s Hospital, The Catholic University of KoreaDepartment of Orthopedic Surgery, Seoul St. Mary’s Hospital, The Catholic University of KoreaAbstract During lateral lumbar interbody fusion (LLIF), unintended intraoperative endplate injury (IEPI) can occur and thereafter lead cage subsidence. The aim of this study was to investigate the incidence of IEPI during LLIF, and its predisposing factors. A retrospective review was conducted on consecutive patients (n = 186; mean age, 70.0 ± 7.6 years) who underwent LLIF at 372 levels. Patient’s demographic and surgical data were compared between patients with and without IEPI. Also, the radiographic data of each level were compared between intact and IEPI segments. IEPI was identified at 76 levels (20.4%) in 65 patients. The incidences of IEPI at every 100 consecutive segments were not different. When 372 segments were analyzed independently, sagittal disc angle (DA) in the extended position (4.3° ± 3.6° at IEPI segments vs. 6.4° ± 4.0° at intact segments), the difference between sagittal DA in the extended position and cage angle (− 2.2° ± 4.0° vs. 0.0° ± 3.9°), and the difference between preoperative disc height and cage height (− 5.4 mm ± 2.4 mm vs. − 4.7 mm ± 2.0 mm) were different significantly. Also, endplate sclerosis was more common at intact segments than IEPI segments (33.2% vs. 17.3%). Multivariate analysis showed that male sex (odds ratio [OR] 0.160; 95% confidence interval [CI] 0.036–0.704), endplate sclerosis (OR 3.307; 95% CI 1.450–8.480), and sagittal DA in the extended position (OR 0.674; 95% CI 0.541–0.840) were significant associated factors for IEPI. IEPI was correlated not with surgeon’s experience, but with patient factors, such as sex, preoperative disc angle, and endplate sclerosis. Careful surgical procedures should be employed for patients with these predisposing factors.https://doi.org/10.1038/s41598-021-99751-6 |
| spellingShingle | Young-Hoon Kim Kee-Yong Ha Ki-Tack Kim Dong-Gune Chang Hyung-Youl Park Eun-Ji Yoon Sang-Il Kim Risk factors for intraoperative endplate injury during minimally-invasive lateral lumbar interbody fusion Scientific Reports |
| title | Risk factors for intraoperative endplate injury during minimally-invasive lateral lumbar interbody fusion |
| title_full | Risk factors for intraoperative endplate injury during minimally-invasive lateral lumbar interbody fusion |
| title_fullStr | Risk factors for intraoperative endplate injury during minimally-invasive lateral lumbar interbody fusion |
| title_full_unstemmed | Risk factors for intraoperative endplate injury during minimally-invasive lateral lumbar interbody fusion |
| title_short | Risk factors for intraoperative endplate injury during minimally-invasive lateral lumbar interbody fusion |
| title_sort | risk factors for intraoperative endplate injury during minimally invasive lateral lumbar interbody fusion |
| url | https://doi.org/10.1038/s41598-021-99751-6 |
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