Abstract
Objective
A retrospective study was performed to compare the clinical and radiological results between local bone graft with a cage and without using a cage in patients treated with posterior lumbar interbody fusion surgery.
Methods
A total of 115 consecutive patients who underwent PLIF in three institutions were evaluated from December 2005 to December 2010. 53 patients received PLIF with local bone graft combined with using one PEEK cage, and 62 patients received the PLIF with local bone graft without using a cage. The clinical data and perioperative complications of the patients in the two groups were recorded. Preoperative and postoperative radiographs were taken to calculate the disc height and the interbody bony fusion rate. Functional outcome was assessed using the Kirkaldy-Willis criteria at the follow-up time. The results between the cage group and no cage group were compared.
Results
The mean follow-up time was 19 months in no cage group and 18.5 months in cage group (P = 0.716). 20.9 % of patients (13 cases) in no cage group and 20.7 % of patients (11 cases) in cage group developed surgical complications perioperatively (P = 0.978). 51.6 % patients in no cage group got excellent functional outcome at the final follow-up while 54.7 % patients in cage group (P = 0.944). The mean interbody bony fusion time was 7.5 ± 4.5 months in no cage group and 8 ± 3.5 months in cage group (P = 0.841). According to the radiographs measurement, no significant difference was found for the disc height at each level between the two groups at the final follow-up.
Conclusion
Local bone graft without a cage is as beneficial as that with a cage for PLIF. Comparing with local bone graft using a single cage, we believe that the purely local bone graft is a more ideal way in single PLIF.
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References
Cloward RB (1953) The treatment of ruptured lumbar intervertebral discs by vertebral body fusion. I. Indications, operative technique, after care. J Neurosurg 10:154–168
Collis JS (1985) Total disc replacement: a modified posterior lumbar interbody fusion: report of 750 cases. Clin Orthop 193:64–67
Lin PM (1985) Posterior lumbar interbody fusion technique: complications and pitfalls. Clin Orthop 193:90–102
Mummaneni PV, Haid RW, Rodts GE (2004) Lumbar interbody fusion: state-of-the-arttechnical advances: invited submission from the Joint Section Meeting on Disorders of the Spine and Peripheral Nerves, March 2004. J Neurosurg Spine 1:24–30
Resnick DK, Choudhri TF, Dailey AT et al (2005) Guidelines for the performance of fusion procedures for degenerative disease of the lumbar spine: part 9: fusion in patients with stenosis and spondylolisthesis. J Neurosurg Spine 2:679–685
Resnick DK, Choudhri TF, Dailey AT et al (2005) Guidelines for the performance of fusion procedures for degenerative disease of the lumbar spine: part 10: fusion following decompression in patients with stenosis without spondylolisthesis. J Neurosurg Spine 2:686–691
Muramatsu K, Hachiya Y, Izawa H et al (2012) Remodeling of heat-treated cortical bone allografts for posterior lumbar interbody fusion: serial 10-year follow-up. Cell Tissue Bank 13:529–536
Linovitz RJ, Peppers TA (2002) Use of an advanced formulation of beta-tricalcium phosphate as a bone extender in interbody lumbar fusion. Orthopedics 25(5 Suppl):s585–s589
Hashimoto T, Shigenobu K, Kanayama M et al (2002) Clinical results of single-level posterior lumbar interbody fusion using the Brantigan I/F carbon cage filled with a mixture of local morselized bone and bioactive ceramic granules. Spine 27:258–262
Kim H, Lee CK, Yeom JS et al (2012) The efficacy of porous hydroxyapatite bone chip as an extender of local bone graft in posterior lumbar interbody fusion. Eur Spine J 21(7):1324–1330
Diedrich O, Kraft CN, Perlick L et al (2001) The posterior lumbar interbody fusion with cages (PLIF) and transpedicular stabilization. Zentralbl Neurochir 62:106–113
Patil SS, Rawall S, Nagad P et al (2011) Outcome of single level instrumented posterior lumbar interbody fusion using corticocancellous laminectomy bone chips. Indian J Orthop 45(6):500–503
Ito Z, Matsuyama Y, Sakai Y et al (2010) Bone union rate with autologous iliac bone versus local bone graft in posterior lumbar interbody fusion. Spine 35(21):E1101–E1105
Ito Z, Imagama S, Kanemura T et al (2013) Bone union rate with autologous iliac bone versus local bone graft in posterior lumbar interbody fusion (PLIF): a multicenter study. Eur Spine J 22:1158–1163
Hu MW, Liu ZL, Zhou Y et al (2012) Posterior lumbar interbody fusion using spinous process and laminae. J Bone Joint Surg Br 94:373–377
Kirkaldy-Willis WH, Paine KW, Cauchoix J et al (1974) Lumbar spinal stenosis. Clin Orthop 99:30–50
Santos ER, Goss DG, Morcom RK et al (2003) Radiologic assessment of interbody fusion using carbon fiber cages. Spine 28:997–1001
Cloward RB (1963) Lesions of the intervertebral disks and their treatment by interbody fusion methods: the painful disk. Clin Orthop 27:51–77
Cloward RB (1981) Spondylolisthesis: treatment by laminectomy and posterior interbody fusion. Clin Orthop 154:74–82
Cloward RB (1985) Posterior lumbar interbody fusion updated. Clin Orthop 193:16–19
Okuyama K, Kido T, Unoki E et al (2007) PLIF with a titanium cage and excised facet joint bone for degenerative spondylolisthesis––in augmentation with a pedicle screw. J Spinal Disord Tech 20:53–59
Chen L, Tang T, Yang H (2003) Complications associated with posterior lumbar interbody fusion using Bagby and Kuslich method for treatment of spondylolisthesis. Chin Med J (Engl) 116:99–103
Miura Y, Imagama S, Yoda M et al (2003) Is local bone viable as a source of bone graft in posterior lumbar interbody fusion? Spine 28:2386–2389
Abdul QR, Qayum MS, Saradhi MV et al (2011) Clinico-radiological profile of indirect neural decompression using cage or autograft as interbody construct in posterior lumbar interbody fusion in spondylolisthesis: which is better? J Craniovertebr Junction Spine 2:12–16
Acknowledgments
This work is supported by Department of Science and Technology Program Funds of Jiangxi Province, China (No. 20123BBG70245 and 20123BBG70037).
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This work is supported by Department of Science and Technology Program Funds of Jiangxi Province, China (No. 20123BBG70245 and 20123BBG70037). No benefits in any form have been or will be received from any commercial party related directly and indirectly to the subject of this manuscript.
Zhili Liu and Jiaming Liu contributed equally to this study and share the first authorship.
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Liu, Z., Liu, J., Tan, Y. et al. A comparative study between local bone graft with a cage and with no cage in single posterior lumbar interbody fusion (PLIF): a multicenter study. Arch Orthop Trauma Surg 134, 1051–1057 (2014). https://doi.org/10.1007/s00402-014-2016-6
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DOI: https://doi.org/10.1007/s00402-014-2016-6