CC BY-NC-ND 4.0 · Asian J Neurosurg 2025; 20(01): 119-125
DOI: 10.1055/s-0044-1796668
Original Article

What Is the Suitable Wide Cage Size for Stand-alone LLIF in Asian Population: A Computed Tomography Scan–Based Study of a Dimension of Lumbar Endplate

1   Spine Unit, Department of Orthopaedic Surgery, Institute of Orthopedics, Lerdsin Hospital, College of Medicine, Rangsit University, Bangkok, Thailand
,
Sahapap Tadee
1   Spine Unit, Department of Orthopaedic Surgery, Institute of Orthopedics, Lerdsin Hospital, College of Medicine, Rangsit University, Bangkok, Thailand
,
Sombat Kunakornsawat
1   Spine Unit, Department of Orthopaedic Surgery, Institute of Orthopedics, Lerdsin Hospital, College of Medicine, Rangsit University, Bangkok, Thailand
,
Suttinont Surapuchong
1   Spine Unit, Department of Orthopaedic Surgery, Institute of Orthopedics, Lerdsin Hospital, College of Medicine, Rangsit University, Bangkok, Thailand
,
Warot Ratanakoosakul
1   Spine Unit, Department of Orthopaedic Surgery, Institute of Orthopedics, Lerdsin Hospital, College of Medicine, Rangsit University, Bangkok, Thailand
,
Kijapat Tiracharnvut
1   Spine Unit, Department of Orthopaedic Surgery, Institute of Orthopedics, Lerdsin Hospital, College of Medicine, Rangsit University, Bangkok, Thailand
,
Pritsanai Pruttikul
1   Spine Unit, Department of Orthopaedic Surgery, Institute of Orthopedics, Lerdsin Hospital, College of Medicine, Rangsit University, Bangkok, Thailand
,
Chaiwat Piyasakulkaew
1   Spine Unit, Department of Orthopaedic Surgery, Institute of Orthopedics, Lerdsin Hospital, College of Medicine, Rangsit University, Bangkok, Thailand
,
Piyabuth Kittithamvongs
2   Research Unit, Department of Orthopaedic Surgery, Institute of Orthopedics, Lerdsin Hospital, College of Medicine, Rangsit University, Bangkok, Thailand
› Author Affiliations
Funding None.

Abstract

Objective The objective of this study is to establish a precise database detailing the width of vertebral endplates, the depth of vertebral endplates (anterior–posterior [A-P] width), and the height of intervertebral discs within the lumbar spine of the Asian population.

Materials and Methods The stand-alone lateral lumbar interbody fusion (LLIF) procedure is increasingly popular for minimally invasive spine surgery and has demonstrated effectiveness in treating various spinal pathologies. Previous studies have indicated that the use of a 26-mm wide cage in stand-alone LLIF can significantly decrease the incidence of cage subsidence. However, most of these studies were conducted on the Caucasian population, which has a larger anatomical structure compared with the Asian population. Consequently, the appropriate wide cage size suitable for stand-alone LLIF in the Asian population has not been previously explored. Ninety-one computed tomography (CT) images were obtained from patients who presented with back pain and had negative imaging results between 2017 and 2021. These images were analyzed using the Picture Archiving Communication System to assess the vertebral body's topography. The analysis involved measuring the vertebral endplate width, vertebral endplate depth (A-P width), and intervertebral disc height.

Results The findings of this study reveal that there is a noticeable increase in the overall width, depth, and intervertebral disc height of the lumbar vertebrae from the upper to the lower regions. Additionally, the morphometric attributes of the lumbar vertebrae observed in this study closely resemble those of Caucasian subjects.

Conclusion The morphometric measurements of the lumbar vertebrae in the Asian population closely resemble those of Caucasian subjects. As a result, it is suggested that a 26-mm wide cage may be a suitable option for stand-alone LLIF in the Asian population.

Ethical Approval

The study was approved by the ethics committee of Lerdsin Hospital.




Publication History

Article published online:
02 December 2024

© 2024. Asian Congress of Neurological Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

 
  • References

  • 1 Cappuccino A, Cornwall GB, Turner AW. et al. Biomechanical analysis and review of lateral lumbar fusion constructs. Spine (Phila Pa 1976) 2010; 35 (26, suppl): S361-S367
  • 2 Lang G, Navarro-Ramirez R, Gandevia L. et al. Elimination of subsidence with 26-mm-wide cages in extreme lateral interbody fusion. World Neurosurg 2017; 104: 644-652
  • 3 Pimenta L, Turner AW, Dooley ZA, Parikh RD, Peterson MD. Biomechanics of lateral interbody spacers: going wider for going stiffer. ScientificWorldJournal 2012; 2012: 381814
  • 4 Marchi L, Abdala N, Oliverira L, Amaral R, Coutinho E, Pimenta L. Stand-alone lateral interbody fusion for the treatment of low-grade degenerative spondylolisthesis. ScientificWorldJournal 2012; 2021: 456364
  • 5 Marchi L, Abdala N, Oliveira L, Amaral R, Coutinho E, Pimenta L. Radiographic and clinical evaluation of cage subsidence after stand-alone lateral interbody fusion. J Neurosurg Spine 2013; 19: 110-118
  • 6 Ozgur BM, Aryan HE, Pimenta L, Taylor WR. Extreme lateral interbody fusion (XLIF): a novel surgical technique for anterior lumbar interbody fusion. Spine J 2006; 6 (04) 435-443
  • 7 Baker JK, Reardon PR, Reardon MJ, Heggeness MH. Vascular injury in anterior lumbar spine surgery. Spine (Phila Pa 1976) 1993; 18: 2227-2230
  • 8 Regan JJ, McAfee PC, Guyer RD, Aronoff RJ. Laparoscopic fusion of the lumbar spine in a multi-center series of the first 34 consecutive patients. Surg Laparosc Endosc 1996; 6: 459-468
  • 9 Christensen FB, Bunger CE. Retrograde ejaculation after retroperitoneal lower lumbar interbody fusion. Int Orthop 1997; 21: 176-180
  • 10 Flynn JC, Price CT. Sexual complications of anterior fusion of the lumbar spine. Spine (Phila Pa 1976) 1984; 9: 489-492
  • 11 Hackenberg L, Liljenqvist U, Halm H, Winkelmann W. Occlusion of the left common iliac artery following anterior lumbar interbody fusion. J Spinal Disord 2001; 14: 365-368
  • 12 Knight RQ, Schwaegler P, Hanscom D, Roh J. Direct lateral lumbar interbody fusion for degenerative conditions: early complication profile. J Spinal Disord Tech 2009; 22: 34-37
  • 13 Daffner SD, Wang JC. Migrated XLIF cage: case report and discussion of surgical technique. Orthopaedics (Glendale Calif) 2010; 33: 518
  • 14 Regev GJ, Haloman S, Chen L. et al. Incidence and prevention of intervertebral cage overhang with minimally invasive lateral approach fusions. Spine (Phila Pa 1976) 2010; 35 (14) 1406-1411
  • 15 Hollowell JP, Vollmer DG, Wilson CR, Pintar FA, Yoganandan N. Biomechanical analysis of thoracolumbar interbody constructs. How important is the endplate?. Spine (Phila Pa 1976) 1996; 21 (09) 1032-1036
  • 16 Lowe TG, Hashim S, Wilson LA. et al. A biomechanical study of regional endplate strength and cage morphology as it related to structural interbody support. Spine (Phila Pa 1976) 2004; 29 (21) 2389-2394
  • 17 Xu DS, Walker CT, Godzik J, Turner JD, Smith W, Uribe JS. Minimally invasive anterior, lateral, and oblique lumbar interbody fusion: a literature review. Ann Transl Med 2018; 6 (06) 104
  • 18 Le TV, Baaj AA, Dakwar E. et al. Subsidence of polyetheretherketone intervertebral cages in minimally invasive lateral retroperitoneal transpsoas lumbar interbody fusion. Spine (Phila Pa 1976) 2012; 37 (14) 1268-1273
  • 19 Kepler CK, Huang RC, Sharma AK. et al. Factors influencing segmental lumbar lordosis after transposes interbody fusion. Orthop Surg 2012; 4 (02) 71-75
  • 20 Kepler CK, Sharma AK, Huang RC. et al. Indirect foramina decompression after lateral transposes interbody fusion. J Neurosurg Spine 2012; 16 (04) 329-333
  • 21 Siu TL, Najafi E, Lin K. A radiographic analysis of cage positioning in lateral transpsoas lumbar interbody fusion. J Orthop 2016; 22 (01) 142-146
  • 22 Marulanda GA, Nayak A, Murtagh R, Santoni BG, Billys JB, Castellvi AE. A cadaveric radiographic analysis on the effect of extreme lateral interbody fusion cage placement with supplementary internal fixation on indirect spine decompression. J Spinal Disord Tech 2014; 27: 263-270
  • 23 Kim MC, Chung HT, Cho JL, Kim DJ, Chung NS. Subsidence of polyetheretherketone cage after minimally invasive transforaminal lumbar interbody fusion. J Spinal Disord Tech 2013; 26: 87-92
  • 24 Bhatia NN, Lee KH, Bui CN, Luna M, Wahba GM, Lee TQ. Biomechanical evaluation of an expandable cage in single-segment posterior lumbar interbody fusion. Spine (Phila Pa 1976) 2012; 37 (02) E79-E85
  • 25 Karikari IO, Grossi PM, Nimjee SM. et al. Minimally invasive lumbar interbody fusion in patients older than 70 years of age: analysis of peri- and postoperative complications. Neurosurgery 2011; 68: 897-902
  • 26 Lau D, Song Y, Guan Z, La Marca F, Park P. Radiologic outcomes of static versus expandable titanium cages after corpectomy: a retrospective cohort analysis of subsidence. Neurosurgery 2013; 72: 529-539
  • 27 Panjabi MM, Goel V, Oxland T. et al. Human lumbar vertebrae. Quantitative three-dimensional anatomy. Spine (Phila Pa 1976) 1992; 17: 299-306
  • 28 Berry JL, Moran JM, Berg WS, Steffee AD. A morphometric study of human lumbar and selected thoracic vertebrae. Spine (Phila Pa 1976) 1987; 12 (04) 362-367
  • 29 Wang Y, Battié MC, Videman T. A morphological study of lumbar vertebral endplates: radiographic, visual and digital measurements. Eur Spine J 2012; 21: 2316-2323
  • 30 Zhou SH, McCarthy ID, McGregor AH, Coombs RH, Hughes SP. Geometrical dimensions of the lower lumbar vertebrae – analysis of data from digitized CT images. Eur Spine J 2000; 9: 242-248
  • 31 Postacchini F, Ripani M, Carpano S. Morphometry of the lumbar vertebrae. An anatomic study in two Caucasoid ethic groups. Clin Orthop Relat Res 1983; (172) 296-303
  • 32 Lakshmanan P, Purushothaman B, Dvorak V, Schratt W, Thambiraj S, Boszczyk M. Sagittal endplate morphology of the lower lumbar spine. Eur Spine J 2012; 21 (Suppl. 02) S160-S164
  • 33 van der Houwen EB, Baron P, Veldhuizen AG, Burgerhof JG, van Ooijen PM, Verkerke GJ. Geometry of the intervertebral volume and vertebral endplates of the human spine. Ann Biomed Eng 2010; 38 (01) 33-40
  • 34 Hall LT, Esses SI, Noble PC, Kamaric E. Morphology of the lumbar vertebral endplates. Spine (Phila Pa 1976) 1998; 23 (14) 1517-1522 , discussion 1522–1523
  • 35 Langrana NA, Kale SP, Edwards WT, Lee CK, Kopacz KJ. Measurement and analyses of the effects of adjacent endplate curvatures on vertebral stresses. Spine J 2006; 6: 267-278
  • 36 Aharinejad S, Bertagnoli R, Wicke K, Firbas W, Schneider B. Morphometric analysis of vertebrae and intervertebral discs as a basis of disc replacement. Am J Anat 1990; 189: 69-76
  • 37 Harrington Jr J, Sungarian A, Rogg J, Makker VJ, Epstein MH. The relation between vertebral endplate shape and lumbar disc herniations. Spine (Phila Pa 1976) 2001; 26 (19) 2133-2138
  • 38 Pappou IP, Cammisa Jr FP, Girardi FP. Correlation of endplate shape on MRI and disc degeneration in surgically treated patients with degenerative disc disease and herniated nucleus pulposus. Spine J 2007; 7: 32-38
  • 39 Tan SH, Teo EC, Chua HC. Quantitative three-dimensional anatomy of lumbar vertebrae in Singaporean Asians. Eur Spine J 2002; 11: 152-158
  • 40 Pan CL, Zhang BY, Zhu YH. et al. Morphologic analysis of Chinese lumbar endplate by three-dimensional computed tomography reconstructions for helping design lumbar disc prosthesis. Medicine (Baltimore) 2021; 100 (06) e24583
  • 41 Chen H, Jiang D, Ou Y, Zhong J, Lv F. Geometry of thoracolumbar vertebral endplates of the human spine. Eur Spine J 2011; 20 (11) 1814-1820