Risk Factors for Pseudarthrosis in Minimally-Invasive Transforaminal Lumbar Interbody Fusion
Study Design Retrospective cohort study (level of evidence: 4). Purpose To describe the potential comorbid, operative, and radiographic risk factors for the development of clinically-relevant pseudarthrosis following minimally-invasive transforaminal lumbar interbody fusion (MIS-TLIF). Overview of L...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
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Korean Spine Society
2018-10-01
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| Series: | Asian Spine Journal |
| Subjects: | |
| Online Access: | http://www.asianspinejournal.org/upload/pdf/asj-2018-12-5-830.pdf |
| _version_ | 1830489038651392000 |
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| author | Arash Emami Michael Faloon Nikhil Sahai Conor J. Dunn Kimona Issa Daniel Thibaudeau Kumar Sinha Ki Soo Hwang |
| author_facet | Arash Emami Michael Faloon Nikhil Sahai Conor J. Dunn Kimona Issa Daniel Thibaudeau Kumar Sinha Ki Soo Hwang |
| author_sort | Arash Emami |
| collection | DOAJ |
| description | Study Design Retrospective cohort study (level of evidence: 4). Purpose To describe the potential comorbid, operative, and radiographic risk factors for the development of clinically-relevant pseudarthrosis following minimally-invasive transforaminal lumbar interbody fusion (MIS-TLIF). Overview of Literature MIS-TLIF has shown long-term clinical outcomes with decreased perioperative morbidity and earlier return to work, similar to those of open TLIF. However, unsuccessful fusion still remains a concern. The impacts of various patient, operative, and radiographic risk factors have not been evaluated for their potential association with pseudarthrosis related to MIS-TLIF. Methods Between 2012 and 2015, 204 consecutive patients underwent one or two-level MIS-TLIF at St. Joseph's University Medical Center, Paterson, NJ, USA; they had a minimum of 1 year of follow-up. The patients were divided into two cohorts: those who developed clinically-relevant pseudarthrosis and those who did not. Clinically-relevant pseudarthrosis was determined by both evidence on computed tomography and presence of continued clinical symptoms at 1-year follow-up. Results Revision surgery was the only identified non-radiographic factor associated with pseudarthrosis. Disc angle had the highest (R2=0.8), followed by anterior disc height (R2=0.79). Although posterior disc height and the ratio of anterior to posterior disc height showed a marked relationship with the outcome, the R2-values were <0.3, thus indicating a less-strong correlation. The overall pseudarthrosis rate was 8%. No statistically significant differences were identified between the two cohorts with respect to mean age, sex, medical comorbidities, smoking status, or number of levels fused. Conclusions Clinically-relevant pseudarthrosis is not uncommon following MIS-TLIF. In the current study, undergoing revision surgery, disc angle, and anterior disc height were observed to be associated with clinically-relevant pseudarthrosis. This study demonstrated that the patient population may benefit from an alternate approach. |
| first_indexed | 2024-12-21T19:30:05Z |
| format | Article |
| id | doaj.art-ec74d1c8a1964fe09221a7b9471266f9 |
| institution | Directory Open Access Journal |
| issn | 1976-1902 1976-7846 |
| language | English |
| last_indexed | 2024-12-21T19:30:05Z |
| publishDate | 2018-10-01 |
| publisher | Korean Spine Society |
| record_format | Article |
| series | Asian Spine Journal |
| spelling | doaj.art-ec74d1c8a1964fe09221a7b9471266f92022-12-21T18:52:44ZengKorean Spine SocietyAsian Spine Journal1976-19021976-78462018-10-0112583083810.31616/asj.2018.12.5.830938Risk Factors for Pseudarthrosis in Minimally-Invasive Transforaminal Lumbar Interbody FusionArash EmamiMichael FaloonNikhil SahaiConor J. DunnKimona IssaDaniel ThibaudeauKumar SinhaKi Soo HwangStudy Design Retrospective cohort study (level of evidence: 4). Purpose To describe the potential comorbid, operative, and radiographic risk factors for the development of clinically-relevant pseudarthrosis following minimally-invasive transforaminal lumbar interbody fusion (MIS-TLIF). Overview of Literature MIS-TLIF has shown long-term clinical outcomes with decreased perioperative morbidity and earlier return to work, similar to those of open TLIF. However, unsuccessful fusion still remains a concern. The impacts of various patient, operative, and radiographic risk factors have not been evaluated for their potential association with pseudarthrosis related to MIS-TLIF. Methods Between 2012 and 2015, 204 consecutive patients underwent one or two-level MIS-TLIF at St. Joseph's University Medical Center, Paterson, NJ, USA; they had a minimum of 1 year of follow-up. The patients were divided into two cohorts: those who developed clinically-relevant pseudarthrosis and those who did not. Clinically-relevant pseudarthrosis was determined by both evidence on computed tomography and presence of continued clinical symptoms at 1-year follow-up. Results Revision surgery was the only identified non-radiographic factor associated with pseudarthrosis. Disc angle had the highest (R2=0.8), followed by anterior disc height (R2=0.79). Although posterior disc height and the ratio of anterior to posterior disc height showed a marked relationship with the outcome, the R2-values were <0.3, thus indicating a less-strong correlation. The overall pseudarthrosis rate was 8%. No statistically significant differences were identified between the two cohorts with respect to mean age, sex, medical comorbidities, smoking status, or number of levels fused. Conclusions Clinically-relevant pseudarthrosis is not uncommon following MIS-TLIF. In the current study, undergoing revision surgery, disc angle, and anterior disc height were observed to be associated with clinically-relevant pseudarthrosis. This study demonstrated that the patient population may benefit from an alternate approach.http://www.asianspinejournal.org/upload/pdf/asj-2018-12-5-830.pdfPseudarthrosisMinimally-invasive transforaminal lumbar interbody fusionRadiographic findingsDisc heightDisc angleRevision surgery |
| spellingShingle | Arash Emami Michael Faloon Nikhil Sahai Conor J. Dunn Kimona Issa Daniel Thibaudeau Kumar Sinha Ki Soo Hwang Risk Factors for Pseudarthrosis in Minimally-Invasive Transforaminal Lumbar Interbody Fusion Asian Spine Journal Pseudarthrosis Minimally-invasive transforaminal lumbar interbody fusion Radiographic findings Disc height Disc angle Revision surgery |
| title | Risk Factors for Pseudarthrosis in Minimally-Invasive Transforaminal Lumbar Interbody Fusion |
| title_full | Risk Factors for Pseudarthrosis in Minimally-Invasive Transforaminal Lumbar Interbody Fusion |
| title_fullStr | Risk Factors for Pseudarthrosis in Minimally-Invasive Transforaminal Lumbar Interbody Fusion |
| title_full_unstemmed | Risk Factors for Pseudarthrosis in Minimally-Invasive Transforaminal Lumbar Interbody Fusion |
| title_short | Risk Factors for Pseudarthrosis in Minimally-Invasive Transforaminal Lumbar Interbody Fusion |
| title_sort | risk factors for pseudarthrosis in minimally invasive transforaminal lumbar interbody fusion |
| topic | Pseudarthrosis Minimally-invasive transforaminal lumbar interbody fusion Radiographic findings Disc height Disc angle Revision surgery |
| url | http://www.asianspinejournal.org/upload/pdf/asj-2018-12-5-830.pdf |
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