title: Predisposing Factors for Intraoperative Endplate Injury of Extreme Lateral Interbody Fusion.
abstract: METHODS
  Retrospective study.
  
  
  OBJECTIVE
  To compare intraoperative endplate injury cases and no injury cases in consecutive series and to identify predisposing factors for intraoperative endplate injury.
  
  
  BACKGROUND
  Unintended endplate violation and subsequent cage subsidence is an intraoperative complication of extreme lateral interbody fusion (XLIF). It is still unknown whether it is derived from inexperienced surgical technique or patients' inherent problems.
  
  
  METHODS
  Consecutive patients (n=102; mean age, 69.0±0.8 years) underwent XLIF at 201 levels at a single institute. Preoperative and immediately postoperative radiographs were compared and cases with intraoperative endplate injury were identified. Various parameters were reviewed in each patient and compared between the injury and no injury groups.
  
  
  RESULTS
  Twenty one levels (10.4%) had signs of intraoperative endplate injury. The injury group had a significantly higher rate of females (p=0.002), lower bone mineral density (BMD) (p=0.02), higher rate of polyetheretherketone as cage material (p=0.04), and taller cage height (p=0.03) compared with the no injury group. Multivariate analysis indicated that a T-score of BMD as a negative (odds ratio, 0.52; 95% confidence interval, 0.27-0.93;p=0.03) and cage height as a positive (odds ratio, 1.84; 95% confidence interval, 1.01-3.17;p=0.03) were predisposing factors for intraoperative endplate injury.
  
  
  CONCLUSIONS
  Intraoperative endplate injury is correlated significantly with reduced BMD and taller cage height. Precise evaluation of bone quality and treatment for osteoporosis might be important and care should be taken not to choose excessively taller cage.
authors: Department of Orthopaedic Surgery, Konan Kosei Hospital, Konan, Japan.
authors: Kotaro
authors: K
authors: Satake
authors: Department of Orthopaedic Surgery, Konan Kosei Hospital, Konan, Japan.
authors: Tokumi
authors: T
authors: Kanemura
authors: Department of Orthopaedic Surgery, Konan Kosei Hospital, Konan, Japan.
authors: Hidetoshi
authors: H
authors: Yamaguchi
authors: Department of Orthopaedic Surgery, Konan Kosei Hospital, Konan, Japan.
authors: Naoki
authors: N
authors: Segi
authors: Department of Orthopaedic Surgery, Konan Kosei Hospital, Konan, Japan.
authors: Jun
authors: J
authors: Ouchida
keywords: Bone-implant interface; Complication; Minimally invasive surgical procedure; Osteoporosis; Spine