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已发表论文
多裂肌萎缩可预测腰椎融合术后椎间融合器沉降
Authors Zhang C, Li C , Wu X, Sun X
Received 12 April 2025
Accepted for publication 14 January 2026
Published 20 January 2026 Volume 2026:19 534086
DOI https://doi.org/10.2147/JPR.S534086
Checked for plagiarism Yes
Review by Single anonymous peer review
Peer reviewer comments 2
Editor who approved publication: Professor King Hei Stanley Lam
Cong Zhang,1,2 Chengming Li,1 Xiaotao Wu,1 Xiaozhi Sun3
1Department of Spine Surgery, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, People’s Republic of China; 2Division of Sports Medicine and Adult Reconstructive Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu, People’s Republic of China; 3Department of Orthopedics, Yizheng Hospital of Traditional Chinese Medicine, Yizheng, Jiangsu, People’s Republic of China
Correspondence: Xiaozhi Sun, Department of orthopedics, Yizheng Hospital of Traditional Chinese Medicine, Yizheng, Jiangsu, 211400, People’s Republic of China, Tel +86-15950562358, Email sxz311@126.com
Objective: Degenerative lumbar spondylolisthesis (DLS) is a common degenerative disease that causes low back pain and lower extremity pain. Transforaminal Lumbar Interbody Fusion (TLIF) is an effective surgical method for treating this condition. However, postoperative complications exist, such as cage subsidence, whose causes are complex. This study investigated the characteristics and risk factors of cage subsidence after TLIF in DLS patients.
Methods: A total of 131 TLIF patients were divided into the subsidence group (subsidence group, n=39) and the non-subsidence group (non-subsidence group, n=92). General patient data were collected, including sex, age, body mass index (BMI), surgical time, intraoperative blood loss, hypertension and diabetes. The imaging data collected included the degree of multifidus muscle atrophy (MMA) at the surgical segment preoperatively; the lumbar lordosis angle, segmental lordosis angle, and intervertebral height before surgery, immediately after surgery, and 12 months postoperatively. Univariable analysis and multivariable logistic regression analysis were used to identify independent risk factors for subsidence after TLIF in patients with DLS.
Results: The degree of MMA before surgery in the subsidence group was significantly greater than that in the non-subsidence group (p< 0.001). There were statistically significant differences in the final follow-up Visual Analogue Scale (VAS) scores for lower back pain and postoperative Oswestry Disability Index (ODI) scores between the two groups. Intervertebral height correction (OR=11.19, p=0.0001), segmental lordosis angle correction (OR=3.43, p=0.0001), and MMA (OR=0.73, p=0.003) were all independent risk factors for cage subsidence.
Conclusion: Intervertebral height correction, segmental lordosis angle correction and MMA were identified as independent risk factors for cage subsidence after TLIF in patients with DLS. In clinical practice, preoperative physiotherapy and core muscle strengthening training aimed at improving the quality of the multifidus muscle can reduce MMA. Meanwhile, selecting an appropriate height for the interbody fusion cage and avoiding excessive correction of the lordotic angle can be used to reduce the incidence of interbody fusion cage subsidence after TLIF and improve patients’ clinical outcomes.
Keywords: lumbar vertebrae, spondylolysis, degenerative lumbar spondylolisthesis, osteoporosis, multifidus muscle
1Department of Spine Surgery, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, People’s Republic of China; 2Division of Sports Medicine and Adult Reconstructive Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu, People’s Republic of China; 3Department of Orthopedics, Yizheng Hospital of Traditional Chinese Medicine, Yizheng, Jiangsu, People’s Republic of China
Correspondence: Xiaozhi Sun, Department of orthopedics, Yizheng Hospital of Traditional Chinese Medicine, Yizheng, Jiangsu, 211400, People’s Republic of China, Tel +86-15950562358, Email sxz311@126.com
Objective: Degenerative lumbar spondylolisthesis (DLS) is a common degenerative disease that causes low back pain and lower extremity pain. Transforaminal Lumbar Interbody Fusion (TLIF) is an effective surgical method for treating this condition. However, postoperative complications exist, such as cage subsidence, whose causes are complex. This study investigated the characteristics and risk factors of cage subsidence after TLIF in DLS patients.
Methods: A total of 131 TLIF patients were divided into the subsidence group (subsidence group, n=39) and the non-subsidence group (non-subsidence group, n=92). General patient data were collected, including sex, age, body mass index (BMI), surgical time, intraoperative blood loss, hypertension and diabetes. The imaging data collected included the degree of multifidus muscle atrophy (MMA) at the surgical segment preoperatively; the lumbar lordosis angle, segmental lordosis angle, and intervertebral height before surgery, immediately after surgery, and 12 months postoperatively. Univariable analysis and multivariable logistic regression analysis were used to identify independent risk factors for subsidence after TLIF in patients with DLS.
Results: The degree of MMA before surgery in the subsidence group was significantly greater than that in the non-subsidence group (p< 0.001). There were statistically significant differences in the final follow-up Visual Analogue Scale (VAS) scores for lower back pain and postoperative Oswestry Disability Index (ODI) scores between the two groups. Intervertebral height correction (OR=11.19, p=0.0001), segmental lordosis angle correction (OR=3.43, p=0.0001), and MMA (OR=0.73, p=0.003) were all independent risk factors for cage subsidence.
Conclusion: Intervertebral height correction, segmental lordosis angle correction and MMA were identified as independent risk factors for cage subsidence after TLIF in patients with DLS. In clinical practice, preoperative physiotherapy and core muscle strengthening training aimed at improving the quality of the multifidus muscle can reduce MMA. Meanwhile, selecting an appropriate height for the interbody fusion cage and avoiding excessive correction of the lordotic angle can be used to reduce the incidence of interbody fusion cage subsidence after TLIF and improve patients’ clinical outcomes.
Keywords: lumbar vertebrae, spondylolysis, degenerative lumbar spondylolisthesis, osteoporosis, multifidus muscle