Quantitative Threshold of Intraoperative Radiological Parameters for Suspecting Oblique Lumbar Interbody Fusion Cage Malposition Triggering Contralateral Radiculopathy.

IF 1.7 Q2 SURGERY International Journal of Spine Surgery Pub Date : 2024-11-08 DOI:10.14444/8617

Satoshi Hattori, Takashi Tanoue, Futoshi Watanabe, Keiji Wada, Shunichi Mori

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Abstract

Background: This study aimed to clarify the quantitative threshold of intraoperative radiological parameters for suspecting posterior malposition of the oblique lumbar interbody fusion (OLIF) cage triggering contralateral radiculopathy.

Methods: We measured the sagittal center and axial rotation angle (ARA) of the cage using postoperative computed tomography (CT) in 130 patients (215 cages) who underwent OLIF. The location of the cage tip was determined from axial magnetic resonance imaging in selected cases based on CT simulations to assess whether the cage was in contact with the contralateral exiting nerve or whether the surgical instruments could contact the nerve during intradiscal maneuvers.

Results: The sagittal center of the cages was on average 41.5% from the anterior edge of the endplate (shown as AC/AP value: anterior end plate edge-cage center/anterior-posterior endplate edge ×100%), and posterior cage positioning ≥50% occurred in 14% of the cages. The ARA was -2.9°, and posterior oblique rotation of the cages ≥10° (ARA ≤ -10°) was observed in 13%. CT simulation showed that the cage tip could directly contact the contralateral nerve when the cage was placed deep in the posterior portion ≥50% of the AC/AP values with concomitant posterior axial rotation ≥10° (ARA ≤ -10°), or deep in an extremely rare portion ≥60% of the AC/AP values with posterior axial rotation ≥0° (ARA ≤ 0°). Six percent of the cages (13/215) were placed in these posterior oblique areas (potential contact area: PCA). Three cages in the PCA were in direct contact with the contralateral nerves, and 9 were placed deep just anterior to the nerves. Symptomatic contralateral radiculopathy occurred in 2 cages (2/13/215, 15.3%/0.9%).

Conclusions: Two intraoperative radiological parameters (AC/AP and ARA) measurable during OLIF procedures may become practical indicators for suspecting cage malposition in PCA and may be available when determining whether to consider cage revision intraoperatively to a more ventral disc space or anteriorly from the opposite endplate edge.

Level of evidence: 4:

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怀疑斜行腰椎椎间融合器固定架错位引发对侧放射病变的术中放射学参数定量阈值

背景：本研究旨在明确术中放射学参数的定量阈值，以怀疑斜行腰椎椎间融合术（OLIF）骨笼后方错位引发对侧根神经病：我们使用术后计算机断层扫描（CT）测量了 130 名接受 OLIF 的患者（215 个椎笼）的椎体笼矢状中心和轴向旋转角（ARA）。在 CT 模拟的基础上，通过轴向磁共振成像确定了部分病例的骨水泥笼顶端位置，以评估骨水泥笼是否与对侧出路神经接触，或在椎间盘内操作时手术器械是否会接触到神经：保持架的矢状中心距终板前缘平均为41.5%（显示为AC/AP值：终板前缘-保持架中心/终板前缘-终板后缘×100%），14%的保持架后方定位≥50%。ARA为-2.9°，13%的患者观察到椎笼后斜旋转≥10°（ARA≤-10°）。CT模拟显示，当保持架放置在AC/AP值≥50%的后部深处，同时后部轴向旋转≥10°（ARA≤-10°），或放置在AC/AP值≥60%的极少数部位深处，同时后部轴向旋转≥0°（ARA≤0°）时，保持架尖端可直接接触对侧神经。6%的骨架（13/215）被放置在这些后斜面区域（潜在接触区：PCA）。PCA 中有 3 个椎笼与对侧神经直接接触，9 个椎笼放置在神经前方的深部。有症状的对侧神经根病发生在2个椎笼（2/13/215，15.3%/0.9%）：结论：OLIF手术中可测量的两个术中放射学参数（AC/AP和ARA）可能成为怀疑PCA中椎笼位置不正的实用指标，并可用于确定是否考虑在术中将椎笼翻修至更腹侧的椎间盘间隙或从对侧终板边缘前移：4:

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

International Journal of Spine Surgery Medicine-Surgery

CiteScore

3.10

自引率

0.00%

发文量

162

期刊介绍： The International Journal of Spine Surgery is the official scientific journal of ISASS, the International Intradiscal Therapy Society, the Pittsburgh Spine Summit, and the Büttner-Janz Spinefoundation, and is an official partner of the Southern Neurosurgical Society. The goal of the International Journal of Spine Surgery is to promote and disseminate online the most up-to-date scientific and clinical research into innovations in motion preservation and new spinal surgery technology, including basic science, biologics, and tissue engineering. The Journal is dedicated to educating spine surgeons worldwide by reporting on the scientific basis, indications, surgical techniques, complications, outcomes, and follow-up data for promising spinal procedures.