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Young-Chul, Dong-Jun, Man-Jun, Jung-Wook, Joon-Hyung, and Woo-Myung: Analysis of the Risk Factors for Posterior Migration of Single Cage after Transforminal Lumbar Interbody Fusion
Original Article

J Korean Orthop Assoc 2019;54(3):237-243.

DOI: https://doi.org/10.4055/jkoa.2019.54.3.237

Analysis of the Risk Factors for Posterior Migration of Single Cage after Transforminal Lumbar Interbody Fusion

Ko Young-Chul, M.D., Ha Dong-Jun, M.D., Park Man-Jun, M.D., Huh Jung-Wook, M.D., Park Joon-Hyung, M.D., Lee Woo-Myung, M.D.

Department of Orthopedic Surgery, Busan Medical Center, Busan, Korea

Correspondence to: Dong-Jun Ha, M.D. Department of Orthopedic Surgery, Busan Medical Center, 359 WorldCup-daero, Yeonje-gu, Busan 47527, Korea TEL: +82-51-607-2550 FAX: +82-51-607-2551 E-mail: mmomjjang@naver.com ORCID: https://orcid.org/0000-0002-1185-738X

Received 18 July 201829 August 2018       Accepted 17 September 2018

Copyright © 2019 The Korean Orthopaedic Association

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose:

To analyze the risk factors for posterior migration of a single cage after transforminal lumbar interbody fusion (TLIF).

Materials and Methods:

This study was conducted retrospectively on 48 patients (60 discs) who were followed-up for 1 year after TLIF from January 2015 to January 2017. The patients were divided into two groups: group 1 containing 16 patients (17 discs) with cage migration and group 2 containing 32 patients (43 discs) without it. Information related to cage migration, such as the demographic factors, shape of disc, level and location of the cage inserted, and disc height change, was acquired from the medical records and radiologic images, and the possibility for generating posterior migration of cage was evaluated statistically.

Results:

The demographic factors and cage-inserted level were similar in the two groups (16 patients in group 1, 32 patients in group 2). In the migration group, number of patients with a pear-type disc, 9 patients, was significantly larger; the disc height change, 1.8 mm, was significantly smaller; and the cage was located frequently on non-center in the anteriorposterior view and center in the lateral view in 9 and 15 out of 16 patients, respectively.

Conclusion:

A pear-type disc shape, small disc height change, cage with non-center on the anteriorposterior view and non-anterior on the lateral view are the risk factors for posterior migration. These factors are important for preventing posterior migration of the cage.

Keywords: transforminal lumbar interbody fusion, single cage, posterior migration, risk factor

References

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Figure 1.
Posterior migration of the cage. Postoperation (A), 3 months after operation (B), 6 months after operation (C), 9 months after operation (D), 12 months after operation (E).
jkoa-54-237f1.tif
Figure 2.
Pear-shaped disc.
jkoa-54-237f2.tif
Figure 3.
Mean disc height. Mean disc height is (a+b)/2. a, anterior disc height; b, posterior disc height.
jkoa-54-237f3.tif
Figure 4.
Location of the cage inserted in the disc space. (A) Anterior posterior view. (B) Lateral view. C, center; A, anterior; P, posterior.
jkoa-54-237f4.tif
Table 1.
Demographic Factors (Mean)
Factor Group 1 (16 patients) Group 2 (32 patients) p-value
Sex     0.087
Male 10 14  
Female 6 18  
Age (yr) 67.5 (48–85) 68.2 (50–85) 0.094
Height (cm) 160.9 (145.8–175.0) 158.2 (140.0–175.0) 0.633
Weight (kg) 62.1 (51.0–73.0) 64.5 (53.4–82.7) 0.285
Body mass index (kg/m2) 24.1 25.9 0.168
Smoking 1 4 0.236

Values are presented as number only, median (range), or mean only.

Table 2.
Radiology Evaluation (Mean)
Factor Group 1 (n=17 discs) Group 2 (n=43 discs) p-value
Disc level     0.169
L2–3 1 (5.9) 1 (2.3)  
L3–4 1 (5.9) 11 (25.6)  
L4–5 12 (70.6) 28 (65.1)  
L5–S1 3 (17.6) 3 (7.0)  
Disc shape     0.027
Non-pear 8 (47.1) 34 (79.1)  
Pear 9 (52.9) 9 (20.9)  
Union rate     0.317
Union 15 (88.2) 41 (95.3)  
Non-union 2 (11.8) 2 (4.7)  
Mean disc height change (mm) 1.8 3.1 0.010
Cage position AP     0.012
Non-center 9 (52.9) 8 (18.6)  
Center 8 (47.1) 35 (81.4)  
Cage position Lat     0.017
Anterior 2 (11.8) 20 (46.5)  
Center 15 (88.2) 23 (53.5)  

Values are presented as number (%) or mean only. AP, anterior-posterior; Lat, lateral.

Table 3.
Intraclass Correlation Coefficient (ICC)
Observer Variable ICC
A Posterior migration of cage 0.996
  Disc height change 0.991
B Posterior migration of cage 0.998
  Disc height change 0.992
Table 4.
Interclass correlation coefficient (Icc)
Variable Observer∗ Icc
Posterior migration of cage A1–B1 0.991
  A2–B2 0.992
Disc height change A1–B1 0.992
  A2–B2 0.993

∗ 1: 1st radiologic reading, 2: 2nd radiologic reading.

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