Influence of the preoperative L5S1 disc state on lateral L2 to L5 fusion's outcomes at an average follow-up of 3,5 years (minimum 2 years).

INTRODUCTION: The impact of pre-existing degeneration of a disc underlying a lumbar arthrodesis via lateral approach on long-term clinical outcome has, to our knowledge, not been studied. When performing arthrodesis between L2 and L5, its extension to L5S1 is challenging because it imposes a different surgical approach. Therefore, surgeon's temptation is to not include L5S1 in the fusion even in case of discopathy. Our objective was to study the influence of the preoperative L5S1 status on the clinical outcome of lumbar lateral interbody fusion (LLIF) using a pre-psoatic approach between L2 and L5 with a minimum follow-up of 2 years. MATERIAL AND METHODS: Patients who underwent LLIF from L2 to L5 between 2015 and 2020 were included in our study. We studied VAS, ODI, and global clinical outcome before surgery and at last follow-up. The L5-S1 disc was radiologically studied in preoperative imaging. Patients were included in two groups (A "with" and B :without" L5-S1 disc degeneration) to compare the clinical outcomes at last follow-up. Our primary objective was to evaluate the rate of L5-S1 disc revision surgery at last follow-up. RESULTS: 102 patients were included. 2 required L5-S1 disc surgery following overlying arthrodesis. Our results showed a significant improvement in the patients' clinical outcomes at the last follow-up (p < 0.0001). We did not find any significant difference on clinical criteria between groups A & B. CONCLUSION: A preop L5S1 disc degeneration does not seem to impact the final clinical outcomes after lumbar lateral interbody fusion at a minimal two years F.U. It should not be systematically involved in an overlying fusion.

Incidence and impact of implant subsidence after stand-alone lateral lumbar interbody fusion.

BACKGROUND: Few data are available on the occurrence after stand-alone lateral lumbar interbody fusion (LLIF) of implant subsidence, whose definition and incidence vary across studies. The primary objective of this work was to determine the incidence of subsidence 1 year postoperatively, using an original measurement method, whose validity was first assessed. The secondary objective was to assess the clinical impact of subsidence. HYPOTHESIS: Implant subsidence after stand-alone LLIF is a common complication that can adversely affect clinical outcomes. MATERIAL AND METHODS: Of 69 included patients who underwent stand-alone LLIF, 67 (97%) were re-evaluated at least 1 year later. Furthermore, 63 (91%) patients had two available computed tomography (CT) scans for assessing subsidence, one performed immediately after surgery and the other 1 year later. Reproducibility of the original measurement method was assessed in a preliminary study. Subsidence was defined as at least 4mm loss of fused space height. RESULTS: The incidence of subsidence was 32% (20 patients). Subsidence was global in 7 (11%) patients and partial in 13 (21%) patients. Mean loss of height was 5.5±1.5mm. Subsidence predominated anteriorly in 50% of cases. The lordotic curvature of the fused segment was altered in 50% of patients, by a mean of 8°±3°. Fusion was achieved in 67/69 (97%) patients. The Oswestry score and visual analogue scale scores for low-back and nerve-root pain were significantly improved after 1 year in the overall population and in the groups with and without subsidence. DISCUSSION: Reproducibility of our measurement method was found to be excellent. Subsidence was common but without significant clinical effects after 1 year. Nevertheless, subsidence can be associated with pain and can result in loss of lumbar lordosis, which is a potential risk factor for degenerative disease of the adjacent segments. A score for predicting the risk of subsidence will now be developed by our group as a tool for improving patient selection to stand-alone LLIF. LEVEL OF EVIDENCE: IV, retrospective cohort study.

Benign febrile cervicalgia due to calcific retropharyngeal tendinitis: case study.

Periarticular calcific tendinopathy has been well described, but no retropharyngeal locations have been reported in the surgical orthopedic literature. This pathology is a diagnostic pitfall, leading to fruitless invasive examinations and treatment. The clinical aspect is misleading, but pathognomic imaging can establish diagnosis. We report a case of febrile postoperative cervicalgia, initially suggestive of a septic complication, but in which imaging indicated retropharyngeal calcific tendinitis.