Study design:

A multicenter retrospective study.

Objective:

This study aimed to elucidate the incidence and risk factors of lateral cage migration (LCM) after lateral lumbar interbody fusion (LLIF) combined with posterior instrumentation.

Summary of background data:

LLIF has recently become a widely accepted procedure for the treatment of lumbar degenerative diseases. Although LLIF complications include vascular, nerve, and abdominal organ injuries, few studies have identified specific risk factors for LCM after LLIF.

Methods:

Between January 2015 and December 2020, 983 patients with lumbar degenerative diseases or osteoporotic vertebral fractures underwent LLIF combined with posterior instrumentation. The fusion sites were located within the lumbosacral lesions. LCM was defined as a change of >3 mm in the movement of the radiopaque marker on radiographs. Patients were classified into LCM and non-LCM groups. The medical records and preoperative radiographs were also reviewed. The 1:5 nearest-neighbor propensity score matching technique was used to compare both groups, and radiological parameters, including preoperative disc height (DH), preoperative sagittal disc angle (SDA), disc geometry, height variance (cage height minus DH), and endplate injury, were analyzed to identify the factors influencing LCM incidence.

Results:

There were 16 patients (1.6%) with LCM (10 men and 6 women; mean age 70.1 y). The Cochran-Armitage trend test showed a linear trend toward an increased rating of LCM with an increasing number of fused segments (P=0.003), and LCM occurred at the terminal cage-inserted disc level in all patients in the LCM group. After propensity-matched analysis, we identified high DH (P<0.001), large SDA (P=0.009), round-type disc (P=0.008), and undersized cage selection (P<0.001) as risk factors for LCM.

Conclusion:

We identified risk factors for LCM after LLIF combined with posterior instrumentation. To avoid this complication, it is important to select the appropriate cage sizes and enhance posterior fixation for at-risk patients.