Fusion Rates of Intervertebral Polyetheretherketone and Titanium Cages without Bone Grafting in Posterior Interbody Lumbar Fusion Surgery for Degenerative Lumbar Instability

Christof von Wrangel; Ali Karakoyun; Kaye-Marie Buchholz; Olaf Süss; Theodoros Kombos; Johannes Woitzik; Peter Vajkoczy; Marcus Czabanka

doi:10.1055/s-0037-1604284

Journal of Neurological Surgery Part A: Central European Neurosurgery, Inhaltsverzeichnis

J Neurol Surg A Cent Eur Neurosurg 2017; 78(06): 556-560
DOI: 10.1055/s-0037-1604284

Original Article

Georg Thieme Verlag KG Stuttgart · New York

Fusion Rates of Intervertebral Polyetheretherketone and Titanium Cages without Bone Grafting in Posterior Interbody Lumbar Fusion Surgery for Degenerative Lumbar Instability

Authors

Christof von Wrangel

¹Department of Neurosurgery, Charité-Universitätsmedizin Berlin, Berlin, Germany
Ali Karakoyun

¹Department of Neurosurgery, Charité-Universitätsmedizin Berlin, Berlin, Germany
Kaye-Marie Buchholz

¹Department of Neurosurgery, Charité-Universitätsmedizin Berlin, Berlin, Germany
Olaf Süss

¹Department of Neurosurgery, Charité-Universitätsmedizin Berlin, Berlin, Germany

²DRK Kliniken Berlin Westend - wirbelsäulenchirurgie und Neurotraumatologie, Berlin, Germany
Theodoros Kombos

¹Department of Neurosurgery, Charité-Universitätsmedizin Berlin, Berlin, Germany

³Department of Neurosurgery, Schlosspark-Klinik GmbH, Berlin, Germany
Johannes Woitzik

¹Department of Neurosurgery, Charité-Universitätsmedizin Berlin, Berlin, Germany
Peter Vajkoczy

¹Department of Neurosurgery, Charité-Universitätsmedizin Berlin, Berlin, Germany
Marcus Czabanka

¹Department of Neurosurgery, Charité-Universitätsmedizin Berlin, Berlin, Germany

Abstract

Background Posterior lumbar interbody fusion (PLIF) surgery is a commonly used procedure for degenerative lumbar instability. Locally harvested bone is usually inserted into intervertebral cages to increase fusion rate. The fusion rate without bone application remains unknown. Our aim was to analyze retrospectively the fusion rates of intervertebral polyetheretherketone (PEEK) and titanium cages in PLIF surgery that were implanted without bone grafting using three-dimensional computed tomography (CT) scanning.

Material and Methods Forty patients (age 43–83 years) with mono- or bisegmental degenerative instability were included. PEEK cages were used in 28 segments (25 patients), and titanium cages were used in 17 segments (15 patients) undergoing PLIF surgery plus pedicle screws. The primary outcome parameter was radiologic fusion rate measured by CT at follow-up. Secondary parameters included rate of implant failure and adjacent segment disease.

Results No difference in mean age between groups was identified (PEEK: 69 ± 10 years; titanium: 62 ± 13 years). Mean follow-up was 39 ± 13 months in PEEK and 24 ± 12 months in the titanium group. Radiologic fusion rate was 32% of operated segments in PEEK and 53% in the titanium group. Screw loosening/adjacent-level disease was observed in 8% and 8% in the PEEK group and in 0% and 7% in the titanium group, respectively.

Conclusion Radiologic fusion rates of PEEK and titanium cages without bone grafting is low in PLIF surgery, and therefore bone grafting should be performed if possible. Rate of implant failure and adjacent-level disease remains low despite reduced osseous fusion in the operated segments.

Keywords

lumbar interbody fusion - PLIF - degenerative lumbar instability

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Referenzen

References
1 Cloward RB. Posterior lumbar interbody fusion updated. Clin Orthop Relat Res 1985; (193) 16-19
2 Lin PM, Cautilli RA, Joyce MF. Posterior lumbar interbody fusion. Clin Orthop Relat Res 1983; (180) 154-168
3 Bono CM, Lee CK. Critical analysis of trends in fusion for degenerative disc disease over the past 20 years: influence of technique on fusion rate and clinical outcome. Spine 2004; 29 (04) 455-463 ; discussion Z5
4 Chau AMT, Xu LL, Wong JH-Y, Mobbs RJ. Current status of bone graft options for anterior interbody fusion of the cervical and lumbar spine. Neurosurg Rev 2014; 37 (01) 23-37
5 Fischer CR, Cassilly R, Cantor W, Edusei E, Hammouri Q, Errico T. A systematic review of comparative studies on bone graft alternatives for common spine fusion procedures. Eur Spine J 2013; 22 (06) 1423-1435
6 Park P, Garton HJ, Gala VC, Hoff JT, McGillicuddy JE. Adjacent segment disease after lumbar or lumbosacral fusion: review of the literature. Spine 2004; 29 (17) 1938-1944
7 Tezeren G, Kuru I. Posterior fixation of thoracolumbar burst fracture: short-segment pedicle fixation versus long-segment instrumentation. J Spinal Disord Tech 2005; 18 (06) 485-488
8 Lamberg TS, Remes VM, Helenius IJ. , et al. Long-term clinical, functional and radiological outcome 21 years after posterior or posterolateral fusion in childhood and adolescence isthmic spondylolisthesis. Eur Spine J 2005; 14 (07) 639-644
9 Kornblum MB, Fischgrund JS, Herkowitz HN, Abraham DA, Berkower DL, Ditkoff JS. Degenerative lumbar spondylolisthesis with spinal stenosis: a prospective long-term study comparing fusion and pseudarthrosis. Spine 2004; 29 (07) 726-733 ; discussion 733–734
10 Tsutsumimoto T, Shimogata M, Yoshimura Y, Misawa H. Union versus nonunion after posterolateral lumbar fusion: a comparison of long-term surgical outcomes in patients with degenerative lumbar spondylolisthesis. Eur Spine J 2008; 17 (08) 1107-1112
11 Arnold PM, Robbins S, Paullus W, Faust S, Holt R, McGuire R. Clinical outcomes of lumbar degenerative disc disease treated with posterior lumbar interbody fusion allograft spacer: a prospective, multicenter trial with 2-year follow-up. Am J Orthop 2009; 38 (07) E115-E122
12 Hirasawa M, Mure H, Toi H, Nagahiro S. Surgical results of lumbar interbody fusion using calcium phosphate cement. Neurol Med Chir (Tokyo) 2014; 54 (09) 722-726
13 Cook SD, Patron LP, Christakis PM, Bailey KJ, Banta C, Glazer PA. Comparison of methods for determining the presence and extent of anterior lumbar interbody fusion. Spine 2004; 29 (10) 1118-1123
14 Blumenthal SL, Gill K. Can lumbar spine radiographs accurately determine fusion in postoperative patients? Correlation of routine radiographs with a second surgical look at lumbar fusions. Spine 1993; 18 (09) 1186-1189
15 Kant AP, Daum WJ, Dean SM, Uchida T. Evaluation of lumbar spine fusion. Plain radiographs versus direct surgical exploration and observation. Spine 1995; 20 (21) 2313-2317
16 Brodsky AE, Kovalsky ES, Khalil MA. Correlation of radiologic assessment of lumbar spine fusions with surgical exploration. Spine 1991; 16 (6, Suppl): S261-S265
17 Shah RR, Mohammed S, Saifuddin A, Taylor BA. Comparison of plain radiographs with CT scan to evaluate interbody fusion following the use of titanium interbody cages and transpedicular instrumentation. Eur Spine J 2003; 12 (04) 378-385
18 Burkus JK, Foley K, Haid RW, LeHuec JC. Surgical Interbody Research Group—radiographic assessment of interbody fusion devices: fusion criteria for anterior lumbar interbody surgery. Neurosurg Focus 2001; 10 (04) E11
19 Agarwal R, Williams K, Umscheid CA, Welch WC. Osteoinductive bone graft substitutes for lumbar fusion: a systematic review. J Neurosurg Spine 2009; 11 (06) 729-740
20 Mummaneni PV, Dhall SS, Eck JC. , et al. Guideline update for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 11: interbody techniques for lumbar fusion. J Neurosurg Spine 2014; 21 (01) 67-74
21 Kandziora F, Schollmeier G, Scholz M. , et al. Influence of cage design on interbody fusion in a sheep cervical spine model. J Neurosurg 2002; 96 (3, Suppl) 321-332
22 Weiner BK, Fraser RD. Spine update lumbar interbody cages. Spine 1998; 23 (05) 634-640