The Results of Posterior Lumbar Inter-body Fusion using PEEK Cage and Pedicle Screw Stabilization in Degenerative Lumbar Spinal Disorders

Kyung-jin Song; Young-jin Lim; Kwang-Bok Lee

doi:10.4055/jkoa.2007.42.4.461

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Song, Lim, and Lee: The Results of Posterior Lumbar Inter-body Fusion using PEEK Cage and Pedicle Screw Stabilization in Degenerative Lumbar Spinal Disorders

Original Article

Journal of the Korean Orthopaedic Association

Journal of the Korean Orthopaedic Association 2007; 42(4): 461-469.

Published online: 31 August 2007

DOI: https://doi.org/10.4055/jkoa.2007.42.4.461

The Results of Posterior Lumbar Inter-body Fusion using PEEK Cage and Pedicle Screw Stabilization in Degenerative Lumbar Spinal Disorders

Kyung-jin Song, M.D., Young-jin Lim, M.D., Kwang-Bok Lee, M.D.^*

Department of Orthopedic Surgery, College of Medicine, Institute for Clinical Medicine, Chonbuk National University Hospital, Jeonju, Korea.

^*Department of Orthopedic Surgery, Cheju National University College of Medicine, Cheju National University Hospital, Jeju, Korea.

Address reprint requests to Kwang-Bok Lee, M.D. Department of Orthopedic Surgery, College of Medicine, Cheju National Universtiy Hospital, 154, Samdo 2-dong, Jeju 690-716, Korea. Tel: +82.64-750-1759, Fax: +82.64-726-0173, osdr2815@cheju.ac.kr

Abstract

Purpose

To evaluate the results of posterior lumbar interbody fusion (PLIF) using PEEK cage with local laminectomized bone and pedicle screws stabilization in multiple segment degenerative lumbar spinal disorders.

Materials and Methods

We performed a retrospective analysis (1 yr follow-up examination) on 152 patients with PLIF using PEEK cage. The 152 patients, were sub-categorized as follows: 1) group A - one level fusion (80 cases), 2) group B - two level fusion (60 cases), and 3) group C - three level fusion (12 cases). We compared each group based on operation time, amount of bleeding, number of complications, sagittal alignment, fusion rate, adjacent segment problems, and evaluation of the clinical result as per the criteria in Kim et al (1991).

Results

For operation time group A took 190.25±40.89 min, group B took 230.46±39.13 min, and group C took 243.25±39.13 min (p=0.08). Furthermore, amount of bleeding for group A was 1,140±704 ml, group B was 1,328±776 ml, and group C was 1,688±756 ml (p=0.07). Consequently, no significant difference was observed between each group. For lumbar lordosis, segmental lordosis, anterior and middle disc height, the last follow-up value was significantly greater than the preoperative value in all three groups. For the adjacent segmental problem, group A had 6 cases, group B had 6 cases, and group C had 2cases. The clinical result revealed a good result in 93.25% for group A, 91.67% for group B, 91.67% for group C. In addition, the fusion rate was 93.75% for group A, 95.00% for group B, and 91.67% for group C. Moreover, the number post-operative complication cases for group A totaled 2 postoperative infections with metal loosening, 5 non-union, and 2 hematomas. Group B had 1 postoperative infection with metal loosening, 3 nonunion, 1 dural tear, and 1 incomplete root injury. Lastly, in group C, 1 complete root injury occurred.

Conclusion

A PLIF using PEEK cage with local laminectomized bone and posterior pedicle screw stabilization in multiple segments should be considered to be a useful surgical method as a result of favorable clinical results and a fusion rate similar to the rate of a single segment.

Keywords: Degenerative spinal disorder, Posterior lumbar interbody fusion, PEEK cage

Figures and Tables

Fig. 1

A 53-year old female with complaints of lower back painwith bilateral sciatica. (A) Preoperative L-spine plain lateral radiogram shows the Meyerding grade isthmic spondylolisthesis on L4-5. (B) Postoperative L-spine plain lateral radiogram shows PEEK cage filled with autogenous laminectomized bone and pedicle screws stabilzation on L4-5. (C) Postoperative 3 months later, L-spine plain lateral radiogram shows bony bridging between L4 and L5 body and the good visualization of grafted bone. (D) Postoperative follow-up (18 months later), L-spine plain lateral radiogram showing complete bony fusion between the L4 and L5 body.

Fig. 2

A 58-year old male with complaints of lower back pain with bilateral sciatica. (A) Preoperative L-spine plain lateral radiogram showing the Meyerding grade I degenerative spondylolisthesis on L4-5 and disc space narrowing on L5-S1. (B) Postoperative L-spine plain lateral radiogram showing the PEEK cage filled with autogenous laminectomized bone and pedicle screw stabilzation on L3-4-5. (C) Postoperative 3 months later, L-spine plain lateral radiogram shows bony bridging between L4 and L5 body and the good visualization of grafted bone. (D) Postoperative 22 months later, L-spine plain lateral radiogram shows complete bony fusion between L3 and L4, L4 and L5 body.

Fig. 3

64-year old female complaints lower back paint with bilateral sciatica. (A) Preoperative L-spine plain lateral radiogram shows the degenerative retrolisthesis on L2-3 and disc space narrowing on L3-4, L4-5. (B) Postoperative follow-up L-spine plain lateral radiogram shows PEEK cage filled with autogenous laminectomized bone and pedicle screw stabilzation on L2-3-4-5. (C) Postoperative follow-up (3 months later), L-spine plain lateral radiogram shows bony bridging between L4 and L5 body and the good visualization of grafted bone. (D) Postoperative follow-up (20 months later), L-spine plain lateral radiogram shows complete bony fusion between L2 and L3, L3 and L4, L4 and L5 body.

Table 1

Patient Data

Table 2

Preopoerative Diagnosis in the Study

^*LSS, Lumbar spinal stenosis; ^†SLT, Spondylolistheis; ^‡P, Pseudoarthrosis; ^§HLD, Herniated lumbar disc.

Table 3

Fusion Level

Table 4

Classification of Fusion Results (Brantigan and Steffee 1991)

Table 5

Criteria for Clinical Result (Kim et al. 1991)

Table 6

Lumbar Lordosis and Segmental Lordosis

Repeated measured ANOVA test. ^*L.L, lumbar lodorsis; ^†S.L, segmental lordosis.

Table 7

The Change of Disc Height from Preoperative to Last Follow-up

Repeated measured ANOVA test; Ant, p=0.09; Mid, p=0.07.

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