Lumbar reconstruction with hyperlordotic cages: Prediction of neuroforaminal height in comparison to established age and sex dependent reference values
Interbody cages are routinely used in lumbar reconstruction surgery of deformity cases for restoration of lordosis and sagittal balance of the spine. However, if hyperlordotic implants are inserted into the intervertebral space, special consideration has to be taken concerning the height of the neur...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2024-02-01
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| Series: | Heliyon |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2405844024017018 |
| _version_ | 1797304410832896000 |
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| author | Denis Bratelj Phillip Jaszczuk Crescenzo Capone Cristian Dragalina Tobias Pötzel Michael Fiechter |
| author_facet | Denis Bratelj Phillip Jaszczuk Crescenzo Capone Cristian Dragalina Tobias Pötzel Michael Fiechter |
| author_sort | Denis Bratelj |
| collection | DOAJ |
| description | Interbody cages are routinely used in lumbar reconstruction surgery of deformity cases for restoration of lordosis and sagittal balance of the spine. However, if hyperlordotic implants are inserted into the intervertebral space, special consideration has to be taken concerning the height of the neural foramen during cage implantation. The greater the lordotic angle of the cage is, the higher the posterior size of the cage needs to be in order to avoid neuroforaminal nerve root impingement. In this technical communication, we propose and clinically validate a stepwise mathematic model to predict neuroforaminal height in patients undergoing lumbar reconstruction with hyperlordotic cages. The length of the superior and inferior vertebral end plates including the height of the neural foramen are measured before implantation of the cage in standing sagittal view x-rays. By assumption of an isosceles triangle in combination with the posterior height and the lordotic angle of the cage, the neuroforaminal height after cage implantation can be estimated. By comparison of the predicted neuroforaminal height with age and sex dependent reference values, nerve root impingement can be avoided by selection of the necessary posterior height of the hyperlordotic cage while still gaining sufficient lumbar lordosis. |
| first_indexed | 2024-03-08T00:10:09Z |
| format | Article |
| id | doaj.art-6e0c18f0e77748aabdb48d142e4f7904 |
| institution | Directory Open Access Journal |
| issn | 2405-8440 |
| language | English |
| last_indexed | 2024-03-08T00:10:09Z |
| publishDate | 2024-02-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Heliyon |
| spelling | doaj.art-6e0c18f0e77748aabdb48d142e4f79042024-02-17T06:41:35ZengElsevierHeliyon2405-84402024-02-01103e25670Lumbar reconstruction with hyperlordotic cages: Prediction of neuroforaminal height in comparison to established age and sex dependent reference valuesDenis Bratelj0Phillip Jaszczuk1Crescenzo Capone2Cristian Dragalina3Tobias Pötzel4Michael Fiechter5Spine and Orthopedic Surgery, Swiss Paraplegic Center, Nottwil, SwitzerlandSpine and Orthopedic Surgery, Swiss Paraplegic Center, Nottwil, SwitzerlandSpine and Orthopedic Surgery, Swiss Paraplegic Center, Nottwil, SwitzerlandSpine and Orthopedic Surgery, Swiss Paraplegic Center, Nottwil, SwitzerlandSpine and Orthopedic Surgery, Swiss Paraplegic Center, Nottwil, SwitzerlandCorresponding author.; Spine and Orthopedic Surgery, Swiss Paraplegic Center, Nottwil, SwitzerlandInterbody cages are routinely used in lumbar reconstruction surgery of deformity cases for restoration of lordosis and sagittal balance of the spine. However, if hyperlordotic implants are inserted into the intervertebral space, special consideration has to be taken concerning the height of the neural foramen during cage implantation. The greater the lordotic angle of the cage is, the higher the posterior size of the cage needs to be in order to avoid neuroforaminal nerve root impingement. In this technical communication, we propose and clinically validate a stepwise mathematic model to predict neuroforaminal height in patients undergoing lumbar reconstruction with hyperlordotic cages. The length of the superior and inferior vertebral end plates including the height of the neural foramen are measured before implantation of the cage in standing sagittal view x-rays. By assumption of an isosceles triangle in combination with the posterior height and the lordotic angle of the cage, the neuroforaminal height after cage implantation can be estimated. By comparison of the predicted neuroforaminal height with age and sex dependent reference values, nerve root impingement can be avoided by selection of the necessary posterior height of the hyperlordotic cage while still gaining sufficient lumbar lordosis.http://www.sciencedirect.com/science/article/pii/S2405844024017018Hyperlordotic cageSagittal balanceNeuroforaminal heightSpineAgeSex |
| spellingShingle | Denis Bratelj Phillip Jaszczuk Crescenzo Capone Cristian Dragalina Tobias Pötzel Michael Fiechter Lumbar reconstruction with hyperlordotic cages: Prediction of neuroforaminal height in comparison to established age and sex dependent reference values Heliyon Hyperlordotic cage Sagittal balance Neuroforaminal height Spine Age Sex |
| title | Lumbar reconstruction with hyperlordotic cages: Prediction of neuroforaminal height in comparison to established age and sex dependent reference values |
| title_full | Lumbar reconstruction with hyperlordotic cages: Prediction of neuroforaminal height in comparison to established age and sex dependent reference values |
| title_fullStr | Lumbar reconstruction with hyperlordotic cages: Prediction of neuroforaminal height in comparison to established age and sex dependent reference values |
| title_full_unstemmed | Lumbar reconstruction with hyperlordotic cages: Prediction of neuroforaminal height in comparison to established age and sex dependent reference values |
| title_short | Lumbar reconstruction with hyperlordotic cages: Prediction of neuroforaminal height in comparison to established age and sex dependent reference values |
| title_sort | lumbar reconstruction with hyperlordotic cages prediction of neuroforaminal height in comparison to established age and sex dependent reference values |
| topic | Hyperlordotic cage Sagittal balance Neuroforaminal height Spine Age Sex |
| url | http://www.sciencedirect.com/science/article/pii/S2405844024017018 |
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