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KMID : 1189320180120050830
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Asian Spine Journal
2018 Volume.12 No. 5 p.830 ~ p.838
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Risk Factors for Pseudarthrosis in Minimally-Invasive Transforaminal Lumbar Interbody Fusion
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Emami Arash
Faloon Michael
Sahai Nikhil
Dunn Conor J.
Issa Kimona
Thibaudeau Daniel
Sinha Kumar
Hwang Ki-Soo
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Abstract
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Study Design: Retrospective cohort study (level of evidence: 4).
Purpose: To describe the potential comorbid, operative, and radiographic risk factors for the development of clinically-relevant pseudarthrosis following minimally-invasive transforaminal lumbar interbody fusion (MIS-TLIF).
Overview of Literature: MIS-TLIF has shown long-term clinical outcomes with decreased perioperative morbidity and earlier return to work, similar to those of open TLIF. However, unsuccessful fusion still remains a concern. The impacts of various patient, operative, and radiographic risk factors have not been evaluated for their potential association with pseudarthrosis related to MIS-TLIF.
Methods: Between 2012 and 2015, 204 consecutive patients underwent one or two-level MIS-TLIF at St. Joseph's University Medical Center, Paterson, NJ, USA; they had a minimum of 1 year of follow-up. The patients were divided into two cohorts: those who developed clinically-relevant pseudarthrosis and those who did not. Clinically-relevant pseudarthrosis was determined by both evidence on computed tomography and presence of continued clinical symptoms at 1-year follow-up.
Results: Revision surgery was the only identified non-radiographic factor associated with pseudarthrosis. Disc angle had the highest (R2=0.8), followed by anterior disc height (R2=0.79). Although posterior disc height and the ratio of anterior to posterior disc height showed a marked relationship with the outcome, the R2-values were <0.3, thus indicating a less-strong correlation. The overall pseudarthrosis rate was 8%. No statistically significant differences were identified between the two cohorts with respect to mean age, sex, medical comorbidities, smoking status, or number of levels fused.
Conclusions: Clinically-relevant pseudarthrosis is not uncommon following MIS-TLIF. In the current study, undergoing revision surgery, disc angle, and anterior disc height were observed to be associated with clinically-relevant pseudarthrosis. This study demonstrated that the patient population may benefit from an alternate approach.
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KEYWORD
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Pseudarthrosis, Minimally-invasive transforaminal lumbar interbody fusion, Radiographic findings, Disc height, Disc angle, Revision surgery
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