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Incidence and risk factors of posterior cage migration following decompression and instrumented fusion for degenerative lumbar disorders.

Abstract The aim of this study was to explore the incidence and risk factors for posterior cage migration (PCM) following decompression and instrumented fusion for degenerative lumbar disorders, and hope to provide references in decision making and surgical planning for spine surgeons.By retrieving the medical records from January 2011 to December 2015, 286 patients were retrospectively reviewed. According to the occurrence of PCM, patients were divided into 2 groups: PCM group and non-PCM (N-PCM). To investigate risk values for PCM, 3 categorized factors were analyzed statistically: patient characteristics: age, sex, body mass index, bone mineral density, duration of disease, diagnosis, comorbidity, smoke; surgical variables: surgery time, blood loss, surgical strategy, cage morphology, cage size, surgical segment, fusion number, source of bone graft, surgeon experience; radiographic parameters: preoperative lumbar lordosis, correction of lumbar lordosis, preoperative lumbar mobility, preoperative intervertebral height, change of intervertebral height, Modic changes, paraspinal muscle degeneration.PCM was detected in 18 of 286 patients (6.3%) at follow-up. There was no statistically significant difference between the 2 groups in patient characteristics, except diagnosis, as lumbar spondylolisthesis was more prevalent in PCM group than that in N-PCM group. There was no difference between the 2 groups in surgical variables, except cage size and surgeon experience, as size of cage was smaller in PCM group than that in N-PCM group, and the surgeons with less experience (less than 3 years) were more prevalent in PCM group than that in N-PCM group. There was no statistically significant difference between 2 groups in radiographic parameters. Logistic regression model revealed that less than 3 years of surgeons' experience, small cage size, and lumbar spondylolisthesis were independently associated with PCM.For patients with lumbar spondylolisthesis, they should be fully informed about the risk of PCM before operation. While for spinal surgeons, large cage should be preferred, and careful manipulation should be adopted, especially for new learners with less than 3-year experience of fusion surgery.
PMID
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Authors

Mayor MeshTerms
Keywords
Journal Title medicine
Publication Year Start

 



PMID- 28816975
OWN - NLM
STAT- In-Process
DA  - 20170817
LR  - 20170908
IS  - 1536-5964 (Electronic)
IS  - 0025-7974 (Linking)
VI  - 96
IP  - 33
DP  - 2017 Aug
TI  - Incidence and risk factors of posterior cage migration following decompression
      and instrumented fusion for degenerative lumbar disorders.
PG  - e7804
LID - 10.1097/MD.0000000000007804 [doi]
AB  - The aim of this study was to explore the incidence and risk factors for posterior
      cage migration (PCM) following decompression and instrumented fusion for
      degenerative lumbar disorders, and hope to provide references in decision making 
      and surgical planning for spine surgeons.By retrieving the medical records from
      January 2011 to December 2015, 286 patients were retrospectively reviewed.
      According to the occurrence of PCM, patients were divided into 2 groups: PCM
      group and non-PCM (N-PCM). To investigate risk values for PCM, 3 categorized
      factors were analyzed statistically: patient characteristics: age, sex, body mass
      index, bone mineral density, duration of disease, diagnosis, comorbidity, smoke; 
      surgical variables: surgery time, blood loss, surgical strategy, cage morphology,
      cage size, surgical segment, fusion number, source of bone graft, surgeon
      experience; radiographic parameters: preoperative lumbar lordosis, correction of 
      lumbar lordosis, preoperative lumbar mobility, preoperative intervertebral
      height, change of intervertebral height, Modic changes, paraspinal muscle
      degeneration.PCM was detected in 18 of 286 patients (6.3%) at follow-up. There
      was no statistically significant difference between the 2 groups in patient
      characteristics, except diagnosis, as lumbar spondylolisthesis was more prevalent
      in PCM group than that in N-PCM group. There was no difference between the 2
      groups in surgical variables, except cage size and surgeon experience, as size of
      cage was smaller in PCM group than that in N-PCM group, and the surgeons with
      less experience (less than 3 years) were more prevalent in PCM group than that in
      N-PCM group. There was no statistically significant difference between 2 groups
      in radiographic parameters. Logistic regression model revealed that less than 3
      years of surgeons' experience, small cage size, and lumbar spondylolisthesis were
      independently associated with PCM.For patients with lumbar spondylolisthesis,
      they should be fully informed about the risk of PCM before operation. While for
      spinal surgeons, large cage should be preferred, and careful manipulation should 
      be adopted, especially for new learners with less than 3-year experience of
      fusion surgery.
FAU - Li, Hua
AU  - Li H
AD  - aDepartment of Spine Surgery, the Halison International Peace Hospital, Hengshui 
      bDepartment of Spine Surgery, The Third Hospital of HeBei Medical University
      cHebei Medical University dFinancial Statistics Department, The Third Hospital of
      HeBei Medical University, Shijiazhuang, China.
FAU - Wang, Hui
AU  - Wang H
FAU - Zhu, Yanbo
AU  - Zhu Y
FAU - Ding, Wenyuan
AU  - Ding W
FAU - Wang, Qian
AU  - Wang Q
LA  - eng
PT  - Journal Article
PL  - United States
TA  - Medicine (Baltimore)
JT  - Medicine
JID - 2985248R
PMC - PMC5571712
EDAT- 2017/08/18 06:00
MHDA- 2017/08/18 06:00
CRDT- 2017/08/18 06:00
AID - 10.1097/MD.0000000000007804 [doi]
AID - 00005792-201708180-00042 [pii]
PST - ppublish
SO  - Medicine (Baltimore). 2017 Aug;96(33):e7804. doi: 10.1097/MD.0000000000007804.