• Tenghui Ge, Zhongning Xu, Jingye Wu, and Yuqing Sun.
• Department of Spine Surgery, Peking University Fourth School of Clinical Medicine, Beijing Jishuitan Hospital, Beijing, People's Republic of China.
• World Neurosurg. 2022 Sep 1; 165: e43e50e43-e50.

BackgroundIntraoperative end plate injury can result in late-onset cage subsidence in oblique lumbar interbody fusion (OLIF). This study aimed to identify risk factors for intraoperative end plate injury and investigate whether a pear-shaped disk correlated with intraoperative end plate injury in OLIF.MethodsWe retrospectively reviewed 102 levels in 82 patients (mean age 60.1 ± 10.0 years) who underwent OLIF for degenerative lumbar diseases. Intraoperative end plate injury was evaluated using midline sagittal computed tomography views at 3 days postoperatively and defined as cage breaching into an adjacent cortical end plate >2 mm. Patient demographics, surgical parameters, radiographic parameters, and cage-related parameters were recorded in all surgical levels. Evaluation of risk factors associated with intraoperative end plate injury was performed. Patient-reported outcome, fusion status, and late-onset cage subsidence were analyzed at a minimum of 1 year after the surgery.ResultsIntraoperative end plate injury was observed in 26 levels (25.5%). Multivariate logistic regression analysis identified that bone mineral density (odds ratio [OR] = 0.978), preoperative segmental lordosis (OR = 0.790), and pear-shaped disk were risk factors (OR = 5.837) for intraoperative end plate injury. Intraoperative end plate injury occurred in 45.5% of levels with a pear-shaped disk compared with 16.0% of levels with no pear-shaped disk (P < 0.01). Late-onset cage subsidence was significantly more frequent in the injury group than the no-injury group. Patient-reported outcome and fusion status were unrelated to intraoperative end plate injury.ConclusionsA pear-shaped disk is the greatest risk factor for intraoperative end plate injury following OLIF.Copyright © 2022 Elsevier Inc. All rights reserved.

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