Brain & spine · 2026
Does adding an interbody cage in L4-L5 posterolateral fusion for degenerative spondylolisthesis and stenosis improve clinical outcome?
Название и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Aimar E, Di Stefano L, Longhitano F, Bona A, Meloni M, Alfiero T, Valente F, Bonomo R, Bonomo G, Tancioni F, Iess G
Аннотация
INTRODUCTION: As the population ages, L4-L5 degenerative spondylolisthesis is increasingly common. Posterolateral fusion was long standard; interbody cages are widely used for perceived higher fusion rates.
RESEARCH QUESTION: Does adding an interbody cage to posterolateral fusion improve outcomes or reduce complications in elderly patients with grade I spondylolisthesis and severe stenosis?
MATERIALS AND METHODS: We retrospectively studied 319 adults aged 60-85 who underwent single-level L4-L5 fusion (2011-2018) after failed conservative care. Patients received posterior lumbar fusion (PLIF, n = 155) or posterolateral lumbar fusion (PLF, n = 164). Primary outcomes were Oswestry Disability Index (ODI) change and complications over a median five-year follow-up; secondary outcomes were operative time, hospital stay, and transfusions. Multivariable analyses adjusted for age, sex, BMI, year of surgery, and sagittal alignment.
RESULTS: Functional improvement was similar (median ODI reduction ≈22 points; p = 0.97), and implant-related revision and revision-free survival did not differ. Cage use increased overall complications (24.5 % vs 7.9 %), prolonged surgery (125 vs 95 min) and hospital stay (4 vs 3 days), and raised transfusions (9.7 % vs 1.8 %), dural tears (11.6 % vs 2.4 %), and radicular deficits (6.5 % vs 1.2 %). The association between cage use and complications persisted after adjustment.
CONCLUSION: In this elderly, low-grade L4-L5 degenerative spondylolisthesis cohort, adding a posterior interbody cage to instrumented posterolateral fusion did not improve 5-year disability but was associated with higher peri-operative morbidity and greater resource use.
RESEARCH QUESTION: Does adding an interbody cage to posterolateral fusion improve outcomes or reduce complications in elderly patients with grade I spondylolisthesis and severe stenosis?
MATERIALS AND METHODS: We retrospectively studied 319 adults aged 60-85 who underwent single-level L4-L5 fusion (2011-2018) after failed conservative care. Patients received posterior lumbar fusion (PLIF, n = 155) or posterolateral lumbar fusion (PLF, n = 164). Primary outcomes were Oswestry Disability Index (ODI) change and complications over a median five-year follow-up; secondary outcomes were operative time, hospital stay, and transfusions. Multivariable analyses adjusted for age, sex, BMI, year of surgery, and sagittal alignment.
RESULTS: Functional improvement was similar (median ODI reduction ≈22 points; p = 0.97), and implant-related revision and revision-free survival did not differ. Cage use increased overall complications (24.5 % vs 7.9 %), prolonged surgery (125 vs 95 min) and hospital stay (4 vs 3 days), and raised transfusions (9.7 % vs 1.8 %), dural tears (11.6 % vs 2.4 %), and radicular deficits (6.5 % vs 1.2 %). The association between cage use and complications persisted after adjustment.
CONCLUSION: In this elderly, low-grade L4-L5 degenerative spondylolisthesis cohort, adding a posterior interbody cage to instrumented posterolateral fusion did not improve 5-year disability but was associated with higher peri-operative morbidity and greater resource use.