Clinical and radiological outcomes in patients who underwent posterior lumbar interbody fusion: comparisons between unilateral and bilateral cage insertion

Abstract Background Although the original technique involves inserting two cages bilaterally, there could be situations that only allow for insertion of one cage unilaterally. However, only a few studies have compared the outcomes between unilateral and bilateral cage insertion. The purpose of this...

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Autores principales:	Jae Hwan Cho, Chang Ju Hwang, Dong-Ho Lee, Choon Sung Lee
Formato:	article
Lenguaje:	EN
Publicado:	BMC 2021
Materias:	Posterior lumbar interbody fusion Cage Outcomes Cohort matching Unilateral Bilateral Diseases of the musculoskeletal system RC925-935
Acceso en línea:	https://doaj.org/article/2016f7da46d648b5a3e3084029ba3636
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spelling	oai:doaj.org-article:2016f7da46d648b5a3e3084029ba36362021-11-21T12:27:55ZClinical and radiological outcomes in patients who underwent posterior lumbar interbody fusion: comparisons between unilateral and bilateral cage insertion10.1186/s12891-021-04852-y1471-2474https://doaj.org/article/2016f7da46d648b5a3e3084029ba36362021-11-01T00:00:00Zhttps://doi.org/10.1186/s12891-021-04852-yhttps://doaj.org/toc/1471-2474Abstract Background Although the original technique involves inserting two cages bilaterally, there could be situations that only allow for insertion of one cage unilaterally. However, only a few studies have compared the outcomes between unilateral and bilateral cage insertion. The purpose of this study was to compare the clinical and radiological outcomes in patients who underwent posterior lumbar interbody fusion (PLIF) between unilaterally and bilaterally inserted cages. Methods Among 206 eligible patients who underwent 1- or 2-level PLIF, 78 patients were 1:3 cohort-matched by age, sex, and operation level (group U, 19 patients with unilateral cages; and group B, 57 patients with bilateral cages). Fusion status was evaluated by computed tomography (CT) scans at postoperative 1 year. Clinical outcomes were measured by visual analog scale (VAS), Oswestry Disability Index (ODI), and EQ-5D. Radiological and clinical parameters were compared between the two groups. Risk factors for pseudarthrosis were also analyzed by multivariate analysis. Results The demographic data were not significantly different between the two groups. However, previous laminectomy, asymmetric disc collapse, and fusion at L5-S1 level were more frequently found in group U (P = 0.003, P = 0.014, and P = 0.014, respectively). Furthermore, pseudarthrosis was more frequently observed in group U (36.8%) than in group B (7.0%) (P = 0.004). Back pain VAS was higher in group U at postoperative 1 year (P = 0.033). Lower general activity function of EQ-5D was observed in group U at postoperative 1 year (P = 0.035). Older age (P = 0.028), unilateral cage (P = 0.007), and higher bone mineral density (P = 0.033) were positively correlated with pseudarthrosis. Conclusions Unilaterally inserted cage might be a possible risk factor for pseudarthrosis when performing PLIF, which could be related with the difficult working conditions such as scars due to previous laminectomy or asymmetric disc collapse. Furthermore, suboptimal clinical outcomes are expected following PLIF with unilateral cage insertion at postoperative 1 year regardless of similar clinical outcomes at postoperative 2 year. Therefore, caution is advised when inserting cages unilaterally, especially under above-mentioned conditions in terms of its possible relationship with symptomatic pseudarthrosis.Jae Hwan ChoChang Ju HwangDong-Ho LeeChoon Sung LeeBMCarticlePosterior lumbar interbody fusionCageOutcomesCohort matchingUnilateralBilateralDiseases of the musculoskeletal systemRC925-935ENBMC Musculoskeletal Disorders, Vol 22, Iss 1, Pp 1-8 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Posterior lumbar interbody fusion Cage Outcomes Cohort matching Unilateral Bilateral Diseases of the musculoskeletal system RC925-935
spellingShingle	Posterior lumbar interbody fusion Cage Outcomes Cohort matching Unilateral Bilateral Diseases of the musculoskeletal system RC925-935 Jae Hwan Cho Chang Ju Hwang Dong-Ho Lee Choon Sung Lee Clinical and radiological outcomes in patients who underwent posterior lumbar interbody fusion: comparisons between unilateral and bilateral cage insertion
description	Abstract Background Although the original technique involves inserting two cages bilaterally, there could be situations that only allow for insertion of one cage unilaterally. However, only a few studies have compared the outcomes between unilateral and bilateral cage insertion. The purpose of this study was to compare the clinical and radiological outcomes in patients who underwent posterior lumbar interbody fusion (PLIF) between unilaterally and bilaterally inserted cages. Methods Among 206 eligible patients who underwent 1- or 2-level PLIF, 78 patients were 1:3 cohort-matched by age, sex, and operation level (group U, 19 patients with unilateral cages; and group B, 57 patients with bilateral cages). Fusion status was evaluated by computed tomography (CT) scans at postoperative 1 year. Clinical outcomes were measured by visual analog scale (VAS), Oswestry Disability Index (ODI), and EQ-5D. Radiological and clinical parameters were compared between the two groups. Risk factors for pseudarthrosis were also analyzed by multivariate analysis. Results The demographic data were not significantly different between the two groups. However, previous laminectomy, asymmetric disc collapse, and fusion at L5-S1 level were more frequently found in group U (P = 0.003, P = 0.014, and P = 0.014, respectively). Furthermore, pseudarthrosis was more frequently observed in group U (36.8%) than in group B (7.0%) (P = 0.004). Back pain VAS was higher in group U at postoperative 1 year (P = 0.033). Lower general activity function of EQ-5D was observed in group U at postoperative 1 year (P = 0.035). Older age (P = 0.028), unilateral cage (P = 0.007), and higher bone mineral density (P = 0.033) were positively correlated with pseudarthrosis. Conclusions Unilaterally inserted cage might be a possible risk factor for pseudarthrosis when performing PLIF, which could be related with the difficult working conditions such as scars due to previous laminectomy or asymmetric disc collapse. Furthermore, suboptimal clinical outcomes are expected following PLIF with unilateral cage insertion at postoperative 1 year regardless of similar clinical outcomes at postoperative 2 year. Therefore, caution is advised when inserting cages unilaterally, especially under above-mentioned conditions in terms of its possible relationship with symptomatic pseudarthrosis.
format	article
author	Jae Hwan Cho Chang Ju Hwang Dong-Ho Lee Choon Sung Lee
author_facet	Jae Hwan Cho Chang Ju Hwang Dong-Ho Lee Choon Sung Lee
author_sort	Jae Hwan Cho
title	Clinical and radiological outcomes in patients who underwent posterior lumbar interbody fusion: comparisons between unilateral and bilateral cage insertion
title_short	Clinical and radiological outcomes in patients who underwent posterior lumbar interbody fusion: comparisons between unilateral and bilateral cage insertion
title_full	Clinical and radiological outcomes in patients who underwent posterior lumbar interbody fusion: comparisons between unilateral and bilateral cage insertion
title_fullStr	Clinical and radiological outcomes in patients who underwent posterior lumbar interbody fusion: comparisons between unilateral and bilateral cage insertion
title_full_unstemmed	Clinical and radiological outcomes in patients who underwent posterior lumbar interbody fusion: comparisons between unilateral and bilateral cage insertion
title_sort	clinical and radiological outcomes in patients who underwent posterior lumbar interbody fusion: comparisons between unilateral and bilateral cage insertion
publisher	BMC
publishDate	2021
url	https://doaj.org/article/2016f7da46d648b5a3e3084029ba3636
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Clinical and radiological outcomes in patients who underwent posterior lumbar interbody fusion: comparisons between unilateral and bilateral cage insertion

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