J Korean Neurosurg Soc.  2019 Jul;62(4):432-441. 10.3340/jkns.2018.0142.

Effect of Cage in Radiological Differences between Direct and Oblique Lateral Interbody Fusion Techniques

• Ko MJ
• Park SW
• Kim YB

• KMID: 2463674
• DOI: http://doi.org/10.3340/jkns.2018.0142

Abstract

OBJECTIVE
Few studies have reported direct comparative data of lumbar spine angles between direct lateral interbody fusion (DLIF) and oblique lateral interbody fusion (OLIF). The purpose of this study was to investigate the clinical and radiological outcomes of DLIF and OLIF, and determine influential factors.
METHODS
The same surgeon performed DLIF from May 2011 to August 2014 (n=201) and OLIF from September 2014 to September 2016 (n=142). Radiological parameters, cage height, cage angle (CA), cage width (CW), and cage location were assessed. We checked the cage location as the distance (mm) from the anterior margin of the disc space to the anterior metallic indicator of the cage in lateral images.
RESULTS
There were significant differences in intervertebral foramen height (FH; 22.0±2.4 vs. 21.0±2.1 mm, p<0.001) and sagittal disc angle (SDA; 8.7±3.3 vs. 11.3±3.2Ëš, p<0.001) between the DLIF and OLIF groups at 7 days postoperatively. CA (9.6±3.0 vs. 8.1±2.9Ëš, p<0.001) and CW (21.2±1.6 vs. 19.2±1.9 mm, p<0.001) were significantly larger in the OLIF group compared to the DLIF group. The cage location of the OLIF group was significantly more anterior than the DLIF group (6.7±3.0 vs. 9.1±3.6 mm, p<0.001). Cage subsidence at 1 year postoperatively was significantly worse in the DLIF group compared to the OLIF group (1.0±1.5 vs. 0.4±1.1 mm, p=0.001). Cage location was significantly correlated with postoperative FH (β=0.273, p<0.001) and postoperative SDA (β=-0.358, p<0.001). CA was significantly correlated with postoperative FH (β=-0.139, p=0.044) and postoperative SDA (β=0.236, p=0.001). Cage location (β=0.293, p<0.001) and CW (β=-0.225, p<0.001) were significantly correlated with cage subsidence.
CONCLUSION
The cage location, CA, and CW seem to be important factors which result in the different-radiological outcomes between DLIF and OLIF.

Keyword

Spinal fusion; Lumbar vertebrae; Instrumentation

MeSH Terms

Lumbar Vertebrae
Spinal Fusion
Spine

Figure

• 

  Fig. 1. As indicated by the white arrow, cage location was measured as the distance (mm) from the anterior margin of the disc to the anterior metallic indicator of the cage in lateral image.

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  Fig. 2. Significant effect of cage location and cage angle on intervertebral FH and SDA. A : DLIF at L4–5, cage location : 13.2 mm, CA : 6°, CH : 12 mm; preoperative FH and SDA were changed from 21.2 mm and 1.4° to 27.5 mm and 3.7° postoperatively. B : OLIF at L4–5, cage location : 5.4 mm, CA : 6°, CH : 12 mm; preoperative FH and SDA were changed from 18.7 mm and 9.8° to 19.2 mm and 13.2° postoperatively. C : DLIF at L4–5, cage location : 10.6 mm, CA : 12°, CH : 14 mm; preoperative FH and SDA were changed from 17.9 mm and 5.7° to 20.24 mm and 10.1° postoperatively. D : OLIF at L4–5, cage location: 4.2 mm, CA : 12°, CH : 14 mm; preoperative FH and SDA were changed from 19.8 mm and -1.7° to 19.9 mm and 14.5° postoperatively. FH : foramen height, SDA : sagittal disc angle, DLIF : direct lateral interbody fusion, CA : cage angle, CH : cage height, OLIF : oblique lateral interbody fusion.

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  Fig. 3. Cage insertion increases the heights of disc space and intervertebral foramen (B) compared to the preoperative state (A), then an additional sagittal angle can be made by posterior shortening with percutaneous rod compressor (C).

Reference

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