Effectiveness of supplemental screw fixation for the prevention of anterior cage migration in oblique lateral interbody fusion at L5-S1 |
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| Affiliation: | 1. Shinoro Orthopedic, 4-5-3-9, Shinoro, Kita-ku, Sapporo, Hokkaido, Japan;2. Graduate School of Health Sciences, Hirosaki University, 66-1, Honcho, Hirosaki-city, Aomori, 036-8564, Japan;3. Department of Physical Therapy, School of Health Sciences, Japan University of Health Sciences, 2-555, Hirasuka, Satte-city, Saitama, 340-0145, Japan;4. Department of Physical Therapy, Kakeyu Hospital, 1308, Kakeyuonsen, Ueda-city, Nagano, 386-0396, Japan;1. Y?ld?r?m Beyaz?t University Faculty of Medicine, Ankara City Hospital, Department of Physical Medicine and Rehabilitation, Ankara, Turkey;2. Y?ld?r?m Beyaz?t University Faculty of Medicine, Ankara City Hospital, Department of Radiology, Ankara, Turkey;3. Ankara City Hospital, Department of Orthopedics and Traumatology, 06000, Ankara, Turkey;1. Department of Orthopaedics, Maharishi Markandeshwar Medical College and Hospital, Solan, Himachal Pradesh, India;2. Department of Radiodiagnosis, All India Institute of Medical Sciences, Bathinda, Punjab, India;3. Department of Orthopaedics, Government Medical College, Patiala, Punjab, India;1. Department of Orthopedic Surgery, Saiseikai Kawaguchi General Hospital, Japan;2. Department of Orthopedic Surgery, Tokyo Medical and Dental University, Japan |
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| Abstract: | BackgroundThe anterior cage at L5-S1 segment is more vulnerable to anterior migration because of the sacral slope, the greater disc angle (DA), the higher shear force, and the weaker pedicle screw fixation at S1. We hypothesized that a supplemental screw (SS) fixation is effective for the prevention of anterior cage migration in oblique lateral interbody fusion (OLIF) at L5-S1.MethodsThis study involved 61 consecutive patients who underwent OLIF at L5-S1 and had more than 1-year regular follow-up. In the first 35 cases, the anterior cage was fixed with pedicle screws only (non-SS group). In the remaining 26 cases, the anterior cage was fixed with a SS and pedicle screws (SS group). Radiological parameters including anterior disc height (ADH), posterior disc height (PDH), DA, cage migration, cage subsidence, and fusion rate at L5-S1 were compared between the two groups.ResultOf the total 61 patients, fifteen (24.6%) patients had an anterior cage migration of >2 mm and six (9.8%) patients had an anterior cage migration of >5 mm. Baseline demographic characteristics were similar between the two groups. The mean cage migration was 2.0 ± 3.1 mm in the non-SS group and 0.9 ± 0.9 mm in the SS group (P = 0.038). Thirteen (37.1%) patients had a cage migration of >2 mm in the non-SS group, while only two (7.7%) had a cage migration of >2 mm in the SS group (P = 0.002). There were no significant differences in the ADH, PDH, DA, cage subsidence, and fusion rate between the two groups (all P > 0.05). There was no SS-related complication in the SS group.ConclusionsSS fixation in front of the anterior L5-S1 cage is simple, safe, and effective for the prevention of anterior cage migration in OLIF at L5-S1. |
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