NDLI: Influence of the geometric and material properties of lumbar endplate on lumbar interbody fusion failure: a systematic review

Content Provider	Springer Nature : BioMed Central
Author	Yu, Yihang Robinson, Dale L. Ackland, David C. Yang, Yi Lee, Peter Vee Sin
Abstract	Background Lumbar interbody fusion (LIF) is an established surgical intervention for patients with leg and back pain secondary to disc herniation or degeneration. Interbody fusion involves removal of the herniated or degenerated disc and insertion of interbody devices with bone grafts into the remaining cavity. Extensive research has been conducted on operative complications such as a failure of fusion or non-union of the vertebral bodies. Multiple factors including surgical, implant, and patient factors influencing the rate of complications have been identified. Patient factors include age, sex, osteoporosis, and patient anatomy. Complications can also be influenced by the interbody cage design. The geometry of the bony endplates as well as their corresponding material properties guides the design of interbody cages, which vary considerably across patients with spinal disorders. However, studies on the effects of such variations on the rate of complications are limited. Therefore, this study aimed to perform a systematic review of lumbar endplate geometry and material property factors in LIF failure. Methods Search keywords included ‘factor/cause for spinal fusion failure/cage subsidence/cage migration/non-union’, ‘lumbar’, and ‘interbody’ in electronic databases PubMed and Scopus with no limits on year of publication. Results In total, 1341 articles were reviewed, and 29 articles were deemed suitable for inclusion. Adverse events after LIF, such as cage subsidence, cage migration, and non-union, resulted in fusion failure; hence, risk factors for adverse events after LIF, notably those associated with lumbar endplate geometry and material properties, were also associated with fusion failure. Those risk factors were associated with shape, concavity, bone mineral density and stiffness of endplate, segmental disc angle, and intervertebral disc height. Conclusions This review demonstrated that decreased contact areas between the cage and endplate, thin and weak bony endplate as well as spinal diseases such as spondylolisthesis and osteoporosis are important causes of adverse events after LIF. These findings will facilitate the selection and design of LIF cages, including customised implants based on patient endplate properties.
Related Links	https://josr-online.biomedcentral.com/counter/pdf/10.1186/s13018-022-03091-8.pdf
Ending Page	16
Page Count	16
Starting Page	1
File Format	HTM / HTML
DOI	10.1186/s13018-022-03091-8
Journal	Journal of Orthopaedic Surgery and Research
Issue Number	1
Volume Number	17
Language	English
Publisher	BioMed Central
Publisher Date	2022-04-10
Access Restriction	Open
Subject Keyword	Orthopedics Surgical Orthopedics Lumbar interbody fusion Lumbar endplate Interbody cage Cage subsidence Cage migration Non-union
Content Type	Text
Resource Type	Article
Subject	Surgery Orthopedics and Sports Medicine
Journal Impact Factor	2.8/2023
5-Year Journal Impact Factor	3/2023

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