Effectiveness of supplemental screw fixation for the prevention of anterior cage migration in oblique lateral interbody fusion at L5-S1

Published:August 04, 2021DOI:



      The anterior cage at L5-S1 segment is more vulnerable to anterior migration because of the sacral slope, the greater disc angle (DA), the higher shear force, and the weaker pedicle screw fixation at S1. We hypothesized that a supplemental screw (SS) fixation is effective for the prevention of anterior cage migration in oblique lateral interbody fusion (OLIF) at L5-S1.


      This study involved 61 consecutive patients who underwent OLIF at L5-S1 and had more than 1-year regular follow-up. In the first 35 cases, the anterior cage was fixed with pedicle screws only (non-SS group). In the remaining 26 cases, the anterior cage was fixed with a SS and pedicle screws (SS group). Radiological parameters including anterior disc height (ADH), posterior disc height (PDH), DA, cage migration, cage subsidence, and fusion rate at L5-S1 were compared between the two groups.


      Of the total 61 patients, fifteen (24.6%) patients had an anterior cage migration of >2 mm and six (9.8%) patients had an anterior cage migration of >5 mm. Baseline demographic characteristics were similar between the two groups. The mean cage migration was 2.0 ± 3.1 mm in the non-SS group and 0.9 ± 0.9 mm in the SS group (P = 0.038). Thirteen (37.1%) patients had a cage migration of >2 mm in the non-SS group, while only two (7.7%) had a cage migration of >2 mm in the SS group (P = 0.002). There were no significant differences in the ADH, PDH, DA, cage subsidence, and fusion rate between the two groups (all P > 0.05). There was no SS-related complication in the SS group.


      SS fixation in front of the anterior L5-S1 cage is simple, safe, and effective for the prevention of anterior cage migration in OLIF at L5-S1.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of Orthopaedic Science
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Pavlov P.W.
        • Spruit M.
        • Havinga M.
        • Anderson P.G.
        • van Limbeek J.
        • Jacobs W.C.
        Anterior lumbar interbody fusion with threaded fusion cages and autologous bone grafts.
        Eur Spine J. 2000 Jun; 9: 224-229
        • Brau S.A.
        Mini-open approach to the spine for anterior lumbar interbody fusion: description of the procedure, results and complications.
        Spine J. 2002 May-Jun; 2: 216-223
        • Elia C.J.
        • Arvind V.
        • Brazdzionis J.
        • Glinski A.
        • Schell B.A.
        • Pierre C.A.
        • Ogunlade J.
        • Chapman J.R.
        • Oskouian R.J.
        90-day readmission rates for single level anterior lumbosacral interbody fusion: a nationwide readmissions database analysis.
        Spine. 2020 Jul; 45 (E864-e70)
        • Lee C.S.
        • Park S.J.
        • Chung S.S.
        • Lee J.Y.
        • Yum T.H.
        • Shin S.K.
        Mini-open anterior lumbar interbody fusion combined with lateral lumbar interbody fusion in corrective surgery for adult spinal deformity.
        Asian Spine J. 2016 Dec; 10: 1023-1032
        • Hynes R.
        Oblique lateral interbody fusion (OLIF) technique and complications in 457 levels L1 to S1.
        Int Society for the Advance of Spine Surg. 2014;
        • Chung N.S.
        • Jeon C.H.
        • Lee H.D.
        • Kweon H.J.
        Preoperative evaluation of left common iliac vein in oblique lateral interbody fusion at L5-S1.
        Eur Spine J. 2017 Nov; 26: 2797-2803
        • Lastfogel J.F.
        • Altstadt T.J.
        • Rodgers R.B.
        • Horn E.M.
        Sacral fractures following stand-alone L5-S1 anterior lumbar interbody fusion for isthmic spondylolisthesis.
        J Neurosurg Spine. 2010 Aug; 13: 288-293
        • Kimura H.
        • Shikata J.
        • Odate S.
        • Soeda T.
        • Yamamura S.
        Risk factors for cage retropulsion after posterior lumbar interbody fusion: analysis of 1070 cases.
        Spine. 2012 Jun; 37: 1164-1169
        • Aunoble S.
        • Hoste D.
        • Donkersloot P.
        • Liquois F.
        • Basso Y.
        • Le Huec J.C.
        Video-assisted ALIF with cage and anterior plate fixation for L5-S1 spondylolisthesis.
        J Spinal Disord Tech. 2006 Oct; 19: 471-476
        • Amaral R.
        • Ferreira R.
        • Marchi L.
        • Jensen R.
        • Nogueira-Neto J.
        • Pimenta L.
        Stand-alone anterior lumbar interbody fusion - complications and perioperative results.
        Rev Bras Ortop. 2017 Sep; 52: 569-574
        • Jaeger A.
        • Giber D.
        • Bastard C.
        • Thiebaut B.
        • Roubineau F.
        • Lachaniette C.
        • Dubory A.
        Risk factors of instrumentation failure and pseudarthrosis after stand-alone L5-S1 anterior lumbar interbody fusion: a retrospective cohort study.
        J Neurosurg Spine. 2019 May; 31: 338-346
        • Szadkowski M.
        • d'Astorg H.
        • Bouhali H.
        • Aleksic I.
        • Ramos-Pascual S.
        • Fière V.
        Outcomes of stand-alone anterior lumbar interbody fusion of L5-S1 using a novel implant with anterior plate fixation.
        Spine J. 2020 Oct; 20: 1618-1628
        • König M.A.
        • Grevitt M.P.
        • Quraishi N.A.
        • Boszczyk B.M.
        The safe use of long screws in L5/S1 stand-alone anterior interbody fusion for olisthesis cases.
        Br J Neurosurg. 2018; 32: 28-31
        • Norotte G.
        • Barrios C.
        Clinical and radiological outcomes after stand-alone ALIF for single L5-S1 degenerative discopathy using a PEEK cage filled with hydroxyapatite nanoparticles without bone graft.
        Clin Neurol Neurosurg. 2018 Feb; 168: 24-29
        • Stosch-Wiechert K.
        • Krenauer A.
        • Siepe C.J.
        [Minimally invasive stand-alone fusion of the lumbosacral junction].
        Operat Orthop Traumatol. 2020 Jun; 32: 192-199
        • Woods K.R.
        • Billys J.B.
        • Hynes R.A.
        Technical description of oblique lateral interbody fusion at L1-L5 (OLIF25) and at L5-S1 (OLIF51) and evaluation of complication and fusion rates.
        Spine J. 2017 Apr; 17: 545-553
        • Hamdan A.D.
        • Malek J.Y.
        • Schermerhorn M.L.
        • Aulivola B.
        • Blattman S.B.
        • Pomposelli Jr., F.B.
        Vascular injury during anterior exposure of the spine.
        J Vasc Surg. 2008 Sep; 48: 650-654
        • Quraishi N.A.
        • Konig M.
        • Booker S.J.
        • Shafafy M.
        • Boszczyk B.M.
        • Grevitt M.P.
        • Mehdian H.
        • Webb J.K.
        Access related complications in anterior lumbar surgery performed by spinal surgeons.
        Eur Spine J. 2013 Mar; 22: S16-S20
        • Kim M.C.
        • Chung H.T.
        • Cho J.L.
        • Kim D.J.
        • Chung N.S.
        Subsidence of polyetheretherketone cage after minimally invasive transforaminal lumbar interbody fusion.
        J Spinal Disord Tech. 2013 Apr; 26: 87-92
        • Bridwell K.H.
        • Lenke L.G.
        • McEnery K.W.
        • Baldus C.
        • Blanke K.
        Anterior fresh frozen structural allografts in the thoracic and lumbar spine. Do they work if combined with posterior fusion and instrumentation in adult patients with kyphosis or anterior column defects?.
        Spine. 1995 Jun; 20: 1410-1418
        • Mun H.Y.
        • Ko M.J.
        • Kim Y.B.
        • Park S.W.
        Usefulness of oblique lateral interbody fusion at L5-S1 level compared to transforaminal lumbar interbody fusion.
        J Korean Neurosurg Soc. 2020 Nov; 63: 723-729
        • Ajiboye R.M.
        • Alas H.
        • Mosich G.M.
        • Sharma A.
        • Pourtaheri S.
        Radiographic and clinical outcomes of anterior and transforaminal lumbar interbody fusions: a systematic review and meta-analysis of comparative studies.
        Clin Spine Surg. 2018 May; 31: E230-E238
        • Abbushi A.
        • Cabraja M.
        • Thomale U.W.
        • Woiciechowsky C.
        • Kroppenstedt S.N.
        The influence of cage positioning and cage type on cage migration and fusion rates in patients with monosegmental posterior lumbar interbody fusion and posterior fixation.
        Eur Spine J. 2009 Nov; 18: 1621-1628
        • Kanno K.
        • Ohtori S.
        • Orita S.
        • Yamauchi K.
        • Eguchi Y.
        • Aoki Y.
        • Nakamura J.
        • Miyagi M.
        • Suzuki M.
        • Kubota G.
        • Inage K.
        • Sainoh T.
        • Sato J.
        • Shiga Y.
        • Abe K.
        • Fujimoto K.
        • Kanamoto H.
        • Toyone T.
        • Inoue G.
        • Hanaoka E.
        • Takahashi K.
        Miniopen oblique lateral L5-s1 interbody fusion: a report of 2 cases.
        Case Rep Orthop. 2014; (2014): 603531
        • Huang C.Y.
        • Yeh K.T.
        • Yu T.C.
        • Lee R.P.
        • Chen I.H.
        • Peng C.H.
        • Liu K.L.
        • Wang J.H.
        • Wu W.T.
        Surgical results of a one-stage combined anterior lumbosacral fusion and posterior percutaneous pedicle screw fixation.
        Tzu Chi Med J. 2018 Jan-Mar; 30: 20-23