Can posterior stand-alone expandable cages safely restore lumbar lordosis? A minimum 5-year follow-up study
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(2020) 15:442
RESEARCH ARTICLE
Open Access
Can posterior stand-alone expandable cages safely restore lumbar lordosis? A minimum 5-year follow-up study Seung-Kook Kim1,2,3, Ogeil Mubarak Elbashier1, Su-chan Lee3 and Woo-Jin Choi4*
Abstract Background: Lumbar lordosis (LL) can be restored, and screw-related complications may be avoided with the stand-alone expandable cage method. However, the long-term spinopelvic changes and safety remain unknown. We aimed to elucidate the long-term radiologic outcomes and safety of this technique. Methods: Data from patients who underwent multi-level stand-alone expandable cage fusion and 80 patients who underwent screw-assisted fusion between February 2007 and December 2012, with at least 5 years of follow-up, were retrospectively analyzed. Segmental angle and translation, short and whole LL, pelvic incidence, pelvic tilt, sacral slope (SS), sagittal vertical axis, thoracic kyphosis, and presence of subsidence, pseudoarthrosis, retropulsion, cage breakage, proximal junctional kyphosis (PJK), and screw malposition were assessed. The relationship between local, lumbar, and spinopelvic effects was investigated. The implant failure rate was considered a measure of procedure effectiveness and safety. Results: In total, 69 cases were included in the stand-alone expandable cage group and 150 cases in the control group. The stand-alone group showed shorter operative time (58.48 ± 11.10 vs 81.43 ± 13.75, P = .00028), lower rate of PJK (10.1% vs 22.5%, P = .03), and restoration of local angle (4.66 ± 3.76 vs 2.03 ± 1.16, P = .000079) than the control group. However, sagittal balance (0.01 ± 2.57 vs 0.50 ± 2.10, P = .07) was not restored, and weakness showed higher rate of subsidence (16.31% vs 4.85%, P = .0018), pseudoarthrosis (9.92% vs 2.42%, P = .02), cage, and retropulsion (3.55% vs 0, P = .01) than the control group. Conclusions: Stand-alone expandable cage fusion can restore local lordosis; however, global sagittal balance was not restored. Furthermore, implant safety has not yet been proven. Keywords: Lumbar lordosis, Proximal junctional kyphosis, Sacral slope, Sagittal imbalance, Stand-alone expandable cage fusion
Background With the global aging society, degenerative lumbar spine disease is becoming a common health issue. Degenerative lumbar spine disease not only causes spinal stenosis but is also related to structural and functional problems. * Correspondence: [email protected] 4 Department of Spine Center, Neurosurgery, Hurisarang Hospital, 618 Gyeryong-ro, Seo-gu, Daejeon 35299, Republic of South Korea Full list of author information is available at the end of the article
One such problem, sagittal imbalance, is a crucial contributing factor to a decreased quality of life [1, 2]. Various approaches have been investigated to restore lumbar lordosis (LL) and sagittal balance. Direct decompression and fusion methods, including posterior lumbar interbody fusion and transforaminal lumbar interbody fusion, can achieve both canal decompression and solid fusion; nonetheless, t
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