Tag: sacral

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Radiographic comparison of L5–S1 lateral anterior lumbar interbody fusion cage subsidence and displacement by fixation strategy: anterior plate versus integrated screws

J Neurosurg Spine 38:126–130, 2023

OBJECTIVE The aim of this study was to radiographically compare cage subsidence and displacement between L5–S1 lateral anterior lumbar interbody fusion (ALIF) cages secured with an anterior buttress plate and cages secured with integrated screws.

METHODS Consecutive patients who underwent L5–S1 lateral ALIF with supplemental posterior fixation by a single surgeon from June 2016 to January 2021 were reviewed. Radiographs were analyzed and compared between the two groups based on the type of fixation used to secure the L5–S1 lateral ALIF cage: 1) anterior buttress plate or 2) integrated screws. The following measurements at L5–S1 were analyzed on radiographs obtained preoperatively, before discharge, and at latest follow-up: 1) anterior disc height, 2) posterior disc height, and 3) segmental lordosis. Cage subsidence and anterior cage displacement were determined radiographically.

RESULTS One hundred thirty-nine patients (mean age 60.0 ± 14.3 years) were included for analysis. Sixty-eight patients were treated with an anterior buttress plate (mean follow-up 12 ± 5 months), and 71 were treated with integrated screws (mean follow-up 9 ± 3 months). Mean age, sex distribution, preoperative L5–S1 lordosis, preoperative L5–S1 anterior disc height, and preoperative L5–S1 posterior disc height were statistically similar between the two groups. After surgery, the segmental L5–S1 lordosis and L5–S1 anterior disc heights significantly improved for both groups, and each respective measurement was similar between the groups at final follow-up. Posterior disc heights significantly increased after surgery with integrated screws but not with the anterior buttress plate. As such, posterior disc heights were significantly greater at final follow-up for integrated screws. Compared with patients who received integrated screws, significantly more patients who received the anterior buttress plate had cage subsidence cranially through the L5 endplate (20.6% vs 2.8%, p < 0.01), cage subsidence caudally through the S1 endplate (27.9% vs 0%, p < 0.01), and anterior cage displacement (22.1% vs 0%, p < 0.01).

CONCLUSIONS In this radiographic analysis of 139 patients who underwent lateral L5–S1 ALIF supplemented by posterior fixation, L5–S1 cages secured with an anterior buttress plate demonstrated significantly higher rates of cage subsidence and anterior cage displacement compared with cages secured with integrated screws. While the more durable stability afforded by cages secured with integrated screws suggests that they may be a more viable fixation strategy for L5–S1 lateral ALIFs, there are multiple factors that can contribute to cage subsidence, and, thus, definitive presumption cannot be made that the findings of this study are directly related to the buttress plate.

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Microsurgical sealing for symptomatic sacral Tarlov cysts: a series of 265 cases

J Neurosurg Spine 37:905–913, 2022

Tarlov cysts (TCs) are a common cystic entity in the sacral canal, with a reported prevalence between 1.5% and 13.2%; 10%–20% of patients are symptomatic and need appropriate clinical intervention. However, the choice of treatment remains controversial. The goal of this study was to describe a new microsurgical sealing technique for symptomatic sacral TCs (SSTCs) as well as its long-term outcomes.

METHODS Microsurgical sealing was performed using a short incision, leakage coverage with a piece of autologous fat, and cyst sealing with fibrin glue. Postoperative data were collected at three stages: discharge, 1-year follow-up, and a follow-up of 3 years or more. According to the improvement in neurological deficits and degree of pain relief, outcomes were divided into four levels: excellent, good, unchanged, and deteriorated.

RESULTS A total of 265 patients with SSTCs were treated with microsurgical sealing from January 2003 to December 2020. The mean follow-up was 44.69 months. The percentages of patients who benefited from the operation (excellent and good) at the three stages were 87.55%, 84.89%, and 80.73%, respectively, while those who received no benefit (unchanged and deteriorated) were 12.45%, 15.11%, and 19.27%, respectively. Of the patients with postoperative MRI, the cysts were reduced in size or disappeared in 209 patients (94.14%). CSF leakage from the wound was observed in 15 patients, and 4 patients experienced an infection at the incision. There were no cases of new-onset nerve injury or aseptic meningitis after the operation.

CONCLUSIONS SSTC patients undergoing microsurgical sealing had persistently high rates of symptom relief and few postoperative complications. Microsurgical sealing is an effective, simple, and low-risk method for treating SSTCs.

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