Spine Surgery and Related Research (Sep 2023)

Unique Characteristics of New Bone Formation Induced by Lateral Lumbar Interbody Fusion Procedure

  • Masanari Takami,
  • Shunji Tsutsui,
  • Motohiro Okada,
  • Keiji Nagata,
  • Hiroshi Iwasaki,
  • Akihito Minamide,
  • Yasutsugu Yukawa,
  • Hiroshi Hashizume,
  • Ryo Taiji,
  • Shizumasa Murata,
  • Takuhei Kozaki,
  • Hiroshi Yamada

DOI
https://doi.org/10.22603/ssrr.2022-0108
Journal volume & issue
Vol. 7, no. 5
pp. 450 – 457

Abstract

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Introduction: Despite the absence of bone grafting in the area outside the cage, lateral bridging callus outside cages (LBC) formation is often observed here following extreme lateral interbody fusion (XLIF) conversely to conventional methods of transforaminal lumbar interbody fusion and posterior lumbar interbody fusion. The LBC, which may increase stabilization and decrease nonunion rate in treated segments, has rarely been described. This study aimed to identify the incidence and associated factors of LBC following XLIF. Methods: We enrolled 136 consecutive patients [56 males, 80 females; mean age 69.6 (42-85) years] who underwent lumbar fusion surgery using XLIF, including L4/5 level with posterior fixation at a single institution between February 2013 and February 2018. One year postoperatively, the treated L4/5 segments were divided into the LBC formation and non-formation groups. Potential influential factors, such as age, sex, body mass index, bone density, height of cages, cage material (titanium or polyetheretherketone [PEEK]), presence or absence of diffuse idiopathic skeletal hyperostosis (DISH), and radiological parameters, were evaluated. Multivariate logistic regression analysis was performed for factors significantly different from the univariate analysis. Results: The incidence of LBC formation was 58.8%. Multivariate logistic regression analysis showed that the length of osteophytes [+1 mm; odds ratio, 1.29; 95% confidence interval, 1.17-1.45; p<0.0001] was significant LBC formation predictive factors. Receiver operating characteristic curve analysis demonstrated that the cut-off value for osteophyte length was 14 mm, the sensitivity was 58.8%, the specificity was 84.4%, and the area under the ROC curve for this model was 0.79. Conclusions: The incidence of LBC formation was 58.8% in L4/5 levels one year after the XLIF procedure. We demonstrated that the length of the osteophyte was significantly associated with LBC formation.

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