PMID- 35788206 OWN - NLM STAT- MEDLINE DCOM- 20220706 LR - 20220716 IS - 1471-2474 (Electronic) IS - 1471-2474 (Linking) VI - 23 IP - 1 DP - 2022 Jul 4 TI - Influence of coronal-morphology of endplate and intervertebral space to cage subsidence and fusion following oblique lumbar interbody fusion. PG - 633 LID - 10.1186/s12891-022-05584-3 [doi] LID - 633 AB - BACKGROUND: Endplate morphology is considered to be one of the influencing factors of cage subsidence after lumbar interbody fusion (LIF). Previous radiographic evaluations on the endplate mostly used sagittal X-ray or MRI. However, there are few studies on the CT evaluation of the endplate and intervertebral space (IVS), especially the evaluation of coronal morphology and its influence on subsidence and fusion after LIF. We aimed to measure and classify the shapes of the endplate and IVS using coronal CT imaging and evaluate the radiographic and clinical outcomes of different shapes of the endplate/IVS following oblique lateral lumbar interbody fusion (OLIF). METHODS: A total of 137 patients (average age 59.1 years, including 75 males and 62 females) who underwent L4-5 OLIF combined with anterolateral fixation from June 2018 to June 2020 were included. The endplate concavity depth (ECD) was measured on the preoperative coronal CT image. According to ECD, the endplate was classified as flat (< 2 mm), shallow (2-4 mm), or deep (> 4 mm). The L4-5 IVS was further classified according to endplate type. The disc height (DH), DH changes, subsidence rate, fusion rate, and Oswestry Disability Index (ODI) in different endplate/IVS shapes were evaluated during 1-year follow up. RESULTS: The ECD of L4 inferior endplate (IEP) was significantly deeper than that of L5 superior endplate (SEP) (4.2 +/- 1.1 vs 1.6 +/- 0.8, P < 0.01). Four types of L4-5 IVS were identified: shallow-shallow (16, 11.7%), shallow-flat (45, 32.9%), deep-shallow (32, 23.4%), and deep-flat (44, 32.1%). A total of 45 (32.9%) cases of cage subsidence were observed. Only one (6.3%) subsidence event occurred in the shallow-shallow group, which was significantly lower than in the other three groups (19 shallow-flat, 6 deep-shallow, and 19 deep-flat) (P < 0.05). Meanwhile, the shallow-shallow group had the highest fusion rate (15, 93.8%) and the highest rate of reach minimal clinically important difference (MCID) ODI among the four types. For a single endplate, the shape of L4 IEP is the main influencing factor of the final interbody fusion rate, and the shallow shape L4 IEP facilitates fusion ( OR = 2.85, p = 0.03). On the other hand, the flat shape L5 SEP was the main risk factor to cage subsidence (OR = 4.36, p < 0.01). CONCLUSION: The L4-5 IVS is asymmetrical on coronal CT view and tends to be fornix-above and flat-down. The shallow-shallow IVS has the lowest subsidence rate and best fusion result, which is possibly because it has a relatively good degree in matching either the upper or lower interface of the cage and endplates. These findings provide a basis for the further improvements in the design of OLIF cages. CI - (c) 2022. The Author(s). FAU - Xie, Tianhang AU - Xie T AD - Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, 37# Wuhou Guoxue road, Chengdu, 610041, China. FAU - Pu, Liming AU - Pu L AD - Department of Medical Statistics, School of Public Health, Sun Yat-Sen University, Guangzhou, China. FAU - Zhao, Long AU - Zhao L AD - Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, 37# Wuhou Guoxue road, Chengdu, 610041, China. FAU - Lu, Yufei AU - Lu Y AD - Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, 37# Wuhou Guoxue road, Chengdu, 610041, China. FAU - Yang, Zhiqiang AU - Yang Z AD - Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, 37# Wuhou Guoxue road, Chengdu, 610041, China. FAU - Wang, Xiandi AU - Wang X AD - Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, 37# Wuhou Guoxue road, Chengdu, 610041, China. FAU - Song, Yueming AU - Song Y AD - Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, 37# Wuhou Guoxue road, Chengdu, 610041, China. FAU - Zeng, Jiancheng AU - Zeng J AD - Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, 37# Wuhou Guoxue road, Chengdu, 610041, China. tomzeng5@126.com. LA - eng PT - Journal Article DEP - 20220704 PL - England TA - BMC Musculoskelet Disord JT - BMC musculoskeletal disorders JID - 100968565 SB - IM MH - Female MH - Humans MH - *Lumbar Vertebrae/diagnostic imaging/surgery MH - Lumbosacral Region MH - Male MH - Middle Aged MH - Radiography MH - *Spinal Fusion/methods PMC - PMC9252057 OTO - NOTNLM OT - Cage subsidence OT - Endplate OT - Fusion OT - Intervertebral space OT - OLIF COIS- The authors have no conflicts of interest to declare. EDAT- 2022/07/06 06:00 MHDA- 2022/07/07 06:00 PMCR- 2022/07/04 CRDT- 2022/07/05 18:17 PHST- 2022/01/08 00:00 [received] PHST- 2022/06/24 00:00 [accepted] PHST- 2022/07/05 18:17 [entrez] PHST- 2022/07/06 06:00 [pubmed] PHST- 2022/07/07 06:00 [medline] PHST- 2022/07/04 00:00 [pmc-release] AID - 10.1186/s12891-022-05584-3 [pii] AID - 5584 [pii] AID - 10.1186/s12891-022-05584-3 [doi] PST - epublish SO - BMC Musculoskelet Disord. 2022 Jul 4;23(1):633. doi: 10.1186/s12891-022-05584-3.