• Hang Shi, Xiao-Hu Wang, Lei Zhu, Lu Chen, Zan-Li Jiang, and Xiao-Tao Wu.
• Department of Spine Surgery, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China.
• World Neurosurg. 2022 Dec 1; 168: e110e118e110-e118.

ObjectiveTo investigate the incidence, distribution characteristics, risk factors, and clinical outcomes of intraoperative endplate injury (EI) following transforaminal lumbar interbody fusion.MethodsPatients who underwent single-level transforaminal lumbar interbody fusion from January 2018 to December 2020 were included. The patients were separated into EI and non-EI groups based on computed tomography obtained immediately postoperatively. Demographic, clinical, and radiographic parameters of all patients were analyzed. Clinical outcomes were evaluated by visual analog scale for low back pain and Oswestry Disability Index.ResultsThis study enrolled 576 patients. Rates of EI were 19.6% (113/576) of patients and 9.9% (114/1152) of endplates. The rate of superior EI was significantly higher than that of inferior EI. The results showed that older age, lower disc height index, and taller cage height were independent risk factors for intraoperative EI. Postoperative drain output, total blood loss, postoperative duration of drainage tube, and postoperative hospital stay in the EI group were significantly greater than in the non-EI group. There were no statistical differences in Oswestry Disability Index and visual analog scale scores at the same time point between the groups.ConclusionsRates of EI were 19.6% of patients and 9.9% of endplates. Superior endplates were more susceptible to injury than inferior endplates. Older age, lower disc height index, and taller cage height were independent risk factors for intraoperative EI. Clinical outcomes were not affected by intraoperative EI during early postoperative follow-up.Copyright © 2022 Elsevier Inc. All rights reserved.

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