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Posterolateral versus circumferential instrumented fusion for monosegmental lumbar degenerative disc disease using an expandable cage

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European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

Abstract

Background

Theoretically, 360° instrumented fusion has been considered to offer better radiological correction than PLF. Despite numerous publications, this correlation is still weak with several controversies in the relative literature.

Purpose

This prospective randomized study was designed to compare the radiological segmental results, complications and outcome of 360° instrumented fusion with the use of a single diagonal expandable PLIF device versus posterolateral pedicle screw fixation in monosegmental lumbar DDD and to show that the use of an novel expandable cage is associated with low PLIF-related complication rate compared to conventional cages reported previously.

Study design

Prospective randomized controlled clinical and radiological study.

Patient sample

Adults who suffered from monosegmental DDD were eligible for enrolment in this trial. We randomly assigned 150 patients to receive either 360° instrumented fusion (group A) with expandable cage or PLF (group B).

Outcome measures

Differences between the two groups regarding clinical parameters and radiographic sagittal measurements after 36 months of follow-up.

Methods

The record included global [T12-S1 lordosis, sagittal global spinal balance (SB) (C7-mid-femoral axis)] and segmental [segmental disc wedging (SDW), anterior (ADHr) and posterior (PDHr) disc height ratio] radiological measurements at the instrumented segment. Additionally, clinical outcome was evaluated with VAS, SF-36 (Physical function and Bodily Pain) and ODI questionnaires. Fusion was evaluated with the use of Christiansen method.

Results

In 73 and 72 participants of group A and B, respectively, who completed follow-up to 36 months, there were no differences with respect to the rate of improvement in SF-36, ODI and VAS scores. However, in the spines of group A, there was a significant increase in anterior disc height ratio (P = 0.0057), posterior disc height (P = 0.016) and segmental disc wedging (P = 0.00021) without subsequent loss of correction. Fusion rate was radiologically shown in 94.5% and 87% spines of group A and B, respectively (P > 0.2). Four and 9 spines in group A and B, respectively, showed non-union at the final observation.

Conclusions

Our findings suggest that 360° fusion offers better sagittal radiological restoration associated with circumferential fusion. However, this difference seemed not to have any medium-term clinical impact. The use of expandable cage was associated with low PLIF-related complications compared to conventional cages.

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Acknowledgments

The authors of this study express their appreciation to the postgraduate students of the Department of Computer Engineering and Informatics, Polytechnic School, University of Patras, Greece, Georgios Korovessis and Eleni Spanou for their assistance in statistical analysis.

Conflict of interest

No benefits in any form have been or will be received from OC commercial party related directly or Indirectly to the subject of this manuscript.

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Correspondence to Panagiotis Korovessis.

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Korovessis, P., Repantis, T., Baikousis, A. et al. Posterolateral versus circumferential instrumented fusion for monosegmental lumbar degenerative disc disease using an expandable cage. Eur J Orthop Surg Traumatol 22, 639–645 (2012). https://doi.org/10.1007/s00590-011-0890-y

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  • DOI: https://doi.org/10.1007/s00590-011-0890-y

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