{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T13:48:19Z","timestamp":1783432099785,"version":"3.54.6"},"reference-count":33,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2021,3,21]],"date-time":"2021-03-21T00:00:00Z","timestamp":1616284800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Orthopaedic Surgery"],"published-print":{"date-parts":[[2021,5]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>To investigate risk factors of cage retropulsion after posterior lumbar interbody fusion (PLIF) in China and to establish a scoring system of cage retropulsion.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>The retrospective analysis was based on two hospital databases. The medical data records of posterior lumbar interbody fusion with cage retropulsion were selected from August 2009 to August 2019. Inclusion and exclusion criteria were set in advance. Risk factors including patients' baseline demographics (age, gender, operation diagnosis time difference), preoperative neurological symptoms, whether the fusion involves single or double segments, screw type, intraoperative compression, preoperative bone mineral density, whether there are neurological symptoms before surgery, whether there is urine dysfunction before surgery, disease type, complete removal of the endplate, and patient's education level. The research endpoint was the retropulsion of fusion cages. The Kaplan\u2013Meier (K\u2010M) method was used to analyze potential risk factors, and multivariate Cox regression was used to identify independent risk factors (<jats:italic>P<\/jats:italic>\u2009&lt;\u20090.05). The Statistical Package for the Social Sciences (version 22.0; SPSS, IBM, Chicago, IL, USA) software was used for statistical analysis, and univariate analysis was used to screen out the factors related to cage retropulsion. All independent risk factors were included to predict the survival time of the retropulsion of cage.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>This study included a total of 32 patients with PLIF between 2009 to 2019. All patients were residents of China. Univariate analysis showed that there were 13 patients over 60\u2009years old and 19 patients under 60\u2009years old. There were 20 male patients and 12 female patients. The surgical diagnosis time was seven patients within 1\u2009month, 17 patients within 1 to 3 months, and eight patients over 3 months. The disease type was 18 cases of lumbar disc herniation, 10 cases of lumbar spinal stenosis, four cases of lumbar spondylolisthesis. The fusion segment was 18 cases of single segment, 14 cases of double segment. The intraoperative compression was seven cases of compression, 25 cases of no compression. The preoperative bone mineral density was 10 cases of low density, 18 cases of normal, four cases of osteoporosis. The screw type was 27 cases of universal screw, five cases of one\u2010way screw. Preoperative neurological symptoms were found in 25 cases and not in seven cases. Preoperative urination dysfunction occurred in 8 cases, whereas 24 cases did not have this dysfunction. The endplate was completely removed in 10 cases and not in 22 cases. Education level was nine cases of primary school education, 10 cases of secondary school, 13 cases of university level. Cox regression analysis showed that intraoperative pressure (hazard ratio [<jats:italic>HR<\/jats:italic>]\u00a0=\u00a04.604, <jats:italic>P<\/jats:italic>\u00a0=\u00a00.015) and complete removal of the endplate (<jats:italic>HR<\/jats:italic>\u00a0=\u00a00.205, <jats:italic>P<\/jats:italic>\u00a0=\u00a00.027) are associated with the time of cage retropulsion. According to the <jats:italic>HR<\/jats:italic> of each factor, the scoring rules were formulated, and the patients were divided into the low\u2010risk group, moderate\u2010risk group, and high\u2010risk group according to the final score. The three median survival times of the three groups were 66\u2009days in the low\u2010risk group, 55\u2009days in the moderate\u2010risk group, and 45\u2009days in the high\u2010risk group, with statistical significance (<jats:italic>P<\/jats:italic>\u2009&lt;\u20090.05).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Intraoperative pressure and complete removal of the intraoperative endplate can be helpful to evaluating the expected time of cage retropulsion in patients with PLIF, and this clinical model guided the selection of postoperative prevention and follow\u2010up treatment.<\/jats:p><\/jats:sec>","DOI":"10.1111\/os.12987","type":"journal-article","created":{"date-parts":[[2021,3,22]],"date-time":"2021-03-22T04:14:57Z","timestamp":1616386497000},"page":"855-862","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":14,"title":["Risk Factors and Scoring System of Cage Retropulsion after Posterior Lumbar Interbody Fusion: A Retrospective Observational Study"],"prefix":"10.1111","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5406-3259","authenticated-orcid":false,"given":"Lei","family":"Peng","sequence":"first","affiliation":[{"name":"Department of Orthopaedics The Eighth Affiliated Hospital, Sun Yat\u2010Sen University  Shenzhen China"},{"name":"Departmentof Orthopaedics The Second Affiliated Hospital, Sun Yat\u2010sen University  Guangzhou China"},{"name":"Department of Orthopaedics The Second Affiliated Hospital of Hunan Normal University, The 921rd Central Hospital of the People's Liberation Army  Changsha China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2746-7068","authenticated-orcid":false,"given":"Jiang","family":"Guo","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics The Eighth Affiliated Hospital, Sun Yat\u2010Sen University  Shenzhen China"},{"name":"Departmentof Orthopaedics The Second Affiliated Hospital, Sun Yat\u2010sen University  Guangzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ji\u2010ping","family":"Lu","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics The Second Affiliated Hospital of Hunan Normal University, The 921rd Central Hospital of the People's Liberation Army  Changsha China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Song","family":"Jin","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics The Eighth Affiliated Hospital, Sun Yat\u2010Sen University  Shenzhen China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peng","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics The Eighth Affiliated Hospital, Sun Yat\u2010Sen University  Shenzhen China"},{"name":"Departmentof Orthopaedics The Second Affiliated Hospital, Sun Yat\u2010sen University  Guangzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hui\u2010yong","family":"Shen","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics The Eighth Affiliated Hospital, Sun Yat\u2010Sen University  Shenzhen China"},{"name":"Departmentof Orthopaedics The Second Affiliated Hospital, Sun Yat\u2010sen University  Guangzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2021,3,21]]},"reference":[{"key":"e_1_2_6_2_1","first-page":"2","article-title":"Lumbar interbody fusion: techniques, indications and comparison of interbody fusion options including PLIF, TLIF, MI\u2010TLIF, OLIF\/ATP, LLIF and ALIF","volume":"1","author":"Mobbs RJ","year":"2015","journal-title":"J Spine Surg"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jocn.2017.06.013"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.brs.0000256473.49791.f4"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.wneu.2018.03.121"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.31616\/asj.2019.0357"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.1097\/BRS.0000000000003492"},{"key":"e_1_2_6_8_1","doi-asserted-by":"publisher","DOI":"10.1126\/scisignal.aad4337"},{"key":"e_1_2_6_9_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10856-016-5712-7"},{"key":"e_1_2_6_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.wneu.2019.09.019"},{"key":"e_1_2_6_11_1","doi-asserted-by":"publisher","DOI":"10.4184\/asj.2016.10.6.1100"},{"key":"e_1_2_6_12_1","doi-asserted-by":"publisher","DOI":"10.14245\/kjs.2013.10.1.25"},{"key":"e_1_2_6_13_1","doi-asserted-by":"publisher","DOI":"10.4184\/asj.2018.12.1.59"},{"key":"e_1_2_6_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.wneu.2016.02.075"},{"key":"e_1_2_6_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijsu.2016.04.025"},{"key":"e_1_2_6_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.wneu.2018.04.085"},{"key":"e_1_2_6_17_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00586-009-1036-3"},{"key":"e_1_2_6_18_1","doi-asserted-by":"publisher","DOI":"10.3171\/2010.3.SPINE09590"},{"key":"e_1_2_6_19_1","doi-asserted-by":"publisher","DOI":"10.3171\/2010.3.SPINE09587"},{"key":"e_1_2_6_20_1","doi-asserted-by":"publisher","DOI":"10.1177\/0300060519867828"},{"key":"e_1_2_6_21_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.brs.0000180402.50500.5b"},{"key":"e_1_2_6_22_1","first-page":"502","article-title":"Treatment of cage displacement after posterior lumbar fusion and internal fixation for degenerative lumbar disease","volume":"35","author":"Jin H","year":"2020","journal-title":"Zhongguo Gu Yu Guan Jie Za Zhi"},{"key":"e_1_2_6_23_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jocn.2016.01.013"},{"key":"e_1_2_6_24_1","first-page":"172","article-title":"Risk factors for implant retropulsion after lumbar interbody fusion","volume":"18","author":"Hu Y","year":"2020","journal-title":"Ji Zhu Wai Ke Za Zhi"},{"key":"e_1_2_6_25_1","first-page":"356","article-title":"Management strategy of cage prolapse after posterior lumbar interbody fusion","volume":"12","author":"Lu WC","year":"2019","journal-title":"Zhongguo Gu Yu Guan Jie Za Zhi"},{"key":"e_1_2_6_26_1","first-page":"16","article-title":"Risk factors for posterior lumbar interbody fusion cage displacement","volume":"14","author":"Lu SB","year":"2016","journal-title":"Ji Zhu Wai Ke Za Zhi"},{"key":"e_1_2_6_27_1","doi-asserted-by":"publisher","DOI":"10.1111\/os.12004"},{"key":"e_1_2_6_28_1","doi-asserted-by":"publisher","DOI":"10.1097\/BRS.0b013e318257f12a"},{"key":"e_1_2_6_29_1","first-page":"21","article-title":"Revision of lumbar interbody fusion cage","volume":"24","author":"Zhang SD","year":"2004","journal-title":"Zhong Hua Gu Ke Za Zhi"},{"key":"e_1_2_6_30_1","first-page":"1093","article-title":"Cause analysis and reoperation strategy of cage displacement after. Lumbar. Interbody fusion","volume":"36","author":"Zhang K","year":"2016","journal-title":"Zhong Hua Gu Ke Za Zhi"},{"key":"e_1_2_6_31_1","first-page":"909","article-title":"Causes and revision of cage prolapse after posterior interbody fusion","volume":"12","author":"Zhang YF","year":"2006","journal-title":"Zhongguo Ji Zhu Ji Sui Za Zhi"},{"key":"e_1_2_6_32_1","doi-asserted-by":"publisher","DOI":"10.1097\/BRS.0b013e3181918aae"},{"key":"e_1_2_6_33_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.spinee.2018.08.007"},{"key":"e_1_2_6_34_1","first-page":"287","article-title":"Effectiveness of nano\u2010hydroxyapatite\/polyamide\u201066 cage in interbody fusion for degenerative lumbar scoliosis","volume":"33","author":"Hu J","year":"2019","journal-title":"Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi"}],"container-title":["Orthopaedic Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/os.12987","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/os.12987","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/os.12987","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,1]],"date-time":"2023-09-01T05:59:59Z","timestamp":1693547999000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/os.12987"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,3,21]]},"references-count":33,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2021,5]]}},"alternative-id":["10.1111\/os.12987"],"URL":"https:\/\/doi.org\/10.1111\/os.12987","archive":["Portico"],"relation":{},"ISSN":["1757-7853","1757-7861"],"issn-type":[{"value":"1757-7853","type":"print"},{"value":"1757-7861","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,3,21]]},"assertion":[{"value":"2020-10-13","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2021-02-18","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2021-03-21","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}