Comparison of Monosegment Instrumented Posterior Lumbar Interbody Fusion with and without a Metal Cage in Degenerative Spine

Jin-Hwan Kim; Sung-Soo Kim; Jung-Hoon Kim; Byung-Jik Kim

doi:10.4055/jkoa.2008.43.2.143

Journal List > J Korean Orthop Assoc > v.43(2) > 1012757

Go to TopGo to Top Go to BottomGo to Bottom

TOOLS

Kim, Kim, Kim, and Kim: Comparison of Monosegment Instrumented Posterior Lumbar Interbody Fusion with and without a Metal Cage in Degenerative Spine

Original Article

Journal of the Korean Orthopaedic Association

Journal of the Korean Orthopaedic Association 2008; 43(2): 143-151.

Published online: 30 April 2008

DOI: https://doi.org/10.4055/jkoa.2008.43.2.143

Comparison of Monosegment Instrumented Posterior Lumbar Interbody Fusion with and without a Metal Cage in Degenerative Spine

Jin-Hwan Kim, M.D., Sung-Soo Kim, M.D.^*, Jung-Hoon Kim, M.D., Byung-Jik Kim, M.D.^†

Department of Orthopaedic Surgery, Inje University Ilsan Paik Hospital, Goyang, Korea.

^*Seoul Spine Institute, Inje Univeristy Sanggye Paik Hospital, Seoul, Korea.

^†Department of Orthopaedic Surgery, College of Medicine, Dongguk University, Goyang, Korea.

Address reprint requests to Sung-Soo Kim, M.D. Seoul Spine Institute, Inje University Sanggye Paik Hospital, 761-1, Sanggye 7-dong, Nowon-gu, Seoul 139-707, Korea. Tel: +82.2-950-1288, Fax: +82.2-934-6342, toetotoe1@sanggyepaik.ac.kr

Abstract

Purpose

To compare the radiological and clinical results of a local bone graft with those of a single cage in monosegement instrumented posterior lumbar interbody fusion (PLIF) for a spinal stenosis or low-grade spondylolisthesis at the L4-5 level.

Materials and Methods

Eighteen patients underwent PLIF using a local bone block and a chip bone without a cage (no-cage group) and 24 patients underwent PLIF using a local bone graft with a single non-threaded metal cage (cage group). All the patients were followed up for a minimum of 2 years. The disc space height, disc lordosis, bone union and clinical results according to Lin's criteria of both groups were reviewed and compared retrospectively

Results

The disc space heights of the no-cage and cage groups increased by 27% and 44% at the immediate postoperative and 12% and 27% at the latest follow-up, respectively. The cage group showed significantly better restoration of the disc space height (p<0.05). There was a significant loss of restored disc space height in both groups at the postoperative 3 month follow-up (p<0.05). The disc lordosis increased by 4.0° in the no-cage group and decreased by 3.8° in the cage group at the latest follow-up. In the cage group, the loss of disc lordosis during the follow-up showed a positive correlation with the loss of the anterior disc (r=0.70, p<0.001) and a negative correlation with the initial restoration rate of the disc space height (r=-0.47, p=0.02). The union rate was 83% in the no-cage group and 96% in the cage group without a significant difference (p>0.05). Clinical satisfactory results were obtained in 72% of the no-cage group and 84% of the cage group without a significant difference (p>0.05).

Conclusion

Both groups had a significant loss of restored disc space height 3 months after surgery. PLIF using a cage showed better restoration of the disc space height but there was significant loss of disc lordosis during the follow-up. A cage with sufficient height is recommended for restoring the disc space as well as preventing a loss of disc lordosis.

Keywords: Degenerative lumbar disease, Posterior lumbar interbody fusion, Local bone, Chip bone, Cage

Figures and Tables

Fig. 1

The method for measuring the disc height. (A) The anteroposterior disc height [(D+D')/2] was calculated using the mean value of D and D'. D was defined as the shortest distance between the anterior border of the lower end plate and a line bisecting the upper end plate. D' was defined as the shortest distance between the posterior border of the upper end plate and a line bisecting the lower end plate. (B) The mid-disc height (D) was defined as the shortest distance between the center of a line bisecting the lower end plate and the line bisecting the upper end plate.

Fig. 2

The lateral radiographs of a sixty-six-year-old male patient suffering from spinal stenosis with disc herniation at L4-5. He was treated with posterior pedicle screw fixation and posterior lumbar interbody fusion using a local bone graft without a cage. (A) The preoperative lateral radiograph showed a disc height of 10.4 mm and disc lordosis of 2.9° at L4-5. (B) The disc height and lordosis improved to 13.1 mm and 9.0° after surgery, respectively. (C) The anteroposterior disc and mid-disc height decreased to 10.9 mm and 12.5 mm, respectively. and disc lordosis decreased slightly to 8.6° at 3 months after surgery. (D) The anteroposterior disc and mid-disc height decreased to 10.4 mm and 10.7 mm, respectively and the disc lordosis decreased to 7.7° at the latest follow-up. Solid bon union was obtained.

Fig. 3

The lateral radiographs of a fifty-five year old female patient with spinal stenosis at L4-5. She was treated with posterior pedicle screw fixation and posterior lumbar interbody fusion using a local bone graft with a cage. (A) The preoperative lateral radiograph showed an anteroposterior disc height of 12.5 mm, mid-disc height of 12.1 mm and disc lordosis of 8.2° at L4-5. (B) The anteroposterior disc height, mid-disc height and disc lordosis improved to 17.2 mm, 16.9 mm and 11.2° after surgery, respectively. (C) The anteroposterior disc height, mid-disc height and disc lordosis decreased to 14.7 mm, 14.2 mm and 9.5° at 3 months after surgery, respectively. (D) The anteroposterior disc height, mid-disc height and disc lordosis decreased to 14.2 mm, 13.9 mm and 5.5° at the latest follow-up, respectively. Solid bone union was obtained.

Table 1

Demographic Data of the No-cage and Cage Groups

Table 2

Lin's Criteria

Table 3

Anteroposterior Disc and Mid-Disc Height and Disc Lordosis before and after Surgery

^*IMPO, immediate postoperative follow-up; ^†PO 3M, follow-up at 3 months after surgery; ^‡Final, final follow-up; ^§Correction, correction rate or degree compared with the preoperative state; ^∥LOC, loss of correction during the follow-up after surgery.

Table 4

Radiological Union and Clinical Results according to Lin's Criteria

References

1. Ahn DK, Jeong KW, Lee S, Choi DJ, Cha SK. Posterior lumbar interbody fusion with chip bone and pedicle screw fixation. Comparative study between local chip bone graft and autoiliac chip bone graft. J Korean Orthop Assoc. 2004. 39:614–620.

2. Arai Y, Takahashi M, Kurosawa H, Shitoto K. Comparative study of iliac bone graft and carbon cage with local bone graft in posterior lumbar interbody fusion. J Orthop Surg. 2002. 10:1–7.

3. Barantigen JW, Steffee AD, Geiger JM. A carbon fiber implant to aid interbody fusion. Mechanical testing. Spine. 1991. 16:Suppl 6. S277–S285.

4. Choy WS, Kim WJ, Kim KH, et al. The results of the posterior lumbar interbody fusion using titanium mesh cage for spondylolisthesis. J Korean Soc Spine Surg. 1999. 6:129–134.

5. Cloward RB. The treatment of ruptured intervertebral disc by vertebral body fusion. Indication, operative techniques and aftercare. J Neurosurg. 1953. 10:154–168.

6. Collis JS. Total disc replacement. A modified posterior lumbar interbody fusion. Report of 750 cases. Clin Orthop Relat Res. 1985. 193:64–67.

7. Enker P, Steffee AD. Interbody fusion and instrumentation. Clin Orthop Relat Res. 1994. 300:90–101.

8. Henley EN Jr, David SM. Lumbar arthrodesis for the treatment of back pain. J Bone Joint Surg Am. 1999. 81:716–730.

9. Hutter CG. Posterior intervertebral fusion. A 25-year study. Clin Orthop Relat Res. 1983. 179:86–96.

10. Kim KT. Lunbar interbody fusion using the cage. J Korean Soc Spine Surg. 2000. 7:183–190.

11. Lin PM, Cautilli RA, Joyce MF. Posterior lumbar interbody fusion. Complicaions and pitfalls. Clin Orthop Relat Res. 1983. 180:154–168.

12. Ma GW. Posterior lumbar interbody fusion with specialized instruments. Clin Orthop Relat Res. 1985. 193:57–63.

13. McAfee PC. Interbody fusion cages in reconstructive operation on the spine. J Bone Joint Sug Am. 1999. 81:859–880.

14. Pope MH, Hanley EN, Matteri RE, Wilder DG, Frymoyer JW. Measurement of intervertebral disc space height. Spine. 1977. 2:282–288.

15. Shin BJ, Kim GJ, Kwon H, Suh YS, Kim YI, Rah SK. Results of PLIF using laminar chips in spinal lesions. J Korean Spine Surg. 1998. 5:284–292.

16. Shin BJ, Kim KJ, Ha SS, Chung SH, Kwon H, Kim YI. Posterior lumbar interbody fusion using laminar bone block. J Korean Spine Surg. 1999. 6:110–116.

17. Simmons JW. Posterior lumbar interbody fusion with posterior elements as chip grafts. Clin Orthop Relat Res. 1985. 193:85–89.

18. Steffee AD, Sitkowski DJ. Reduction and stabilization of grade IV spondylolisthesis. Clin Orthop Relat Res. 1998. 227:82–89.

19. Suk SI, Lee CK, Kim WJ, Lee JH, Cho KJ, Kim HG. Adding posterior lumbar interbody fusion to pedicle screw fixation and posterolateral fusion after decomprssion in spondylolytic spondylolisthesis. Spine. 1997. 22:210–219.

20. Takeda M. Experience in posterior lumbar interbody fusion: unicortical versus bicortical autografts. Clin Orthop Relat Res. 1985. 193:120–126.

21. Verlooy J, De Smedt K, Selosse P. Failure of a modified posterior lumbar interbody fusion technique to produce adequate pain relief in isthmic spondylolytic grade I spondylolisthesis patients. Spine. 1993. 18:1491–1495.

22. Weiner BK, Fraser RD. Spine update lmbar interbody cages. Spine. 1998. 23:634–640.

23. Wetzel FT, LaRocca H. The failed posterior lumbar interbody fusion. Spine. 1991. 16:839–845.

TOOLS

Similar articles