Posterior Lumbar Interbody Fusion Using Titanium Cages and Morselized Local Bone Autograft

Jae-Chul Lee; Joo-Seok Cha; Hwa-Yong Song; Yon-Il Kim; Byung-Joon Shin

doi:10.4184/jkss.2006.13.4.284

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Lee, Cha, Song, Kim, and Shin: Posterior Lumbar Interbody Fusion Using Titanium Cages and Morselized Local Bone Autograft

Original Article

Journal of Korean Spine Surg 2006;13(4):284-291.

Published online: 21 February 2006

DOI: https://doi.org/10.4184/jkss.2006.13.4.284

Posterior Lumbar Interbody Fusion Using Titanium Cages and Morselized Local Bone Autograft

Jae-Chul Lee, M.D., Joo-Seok Cha, M.D., Hwa-Yong Song, M.D., Yon-Il Kim, M.D., Byung-Joon Shin, M.D.

Department of Orthopaedic Surgery, Soonchunhyang University College of Medicine, Seoul, Korea

Address reprint requests to Byung-Joon Shin, M.D. Department of Orthopedic Surgery, Spine Center, College of Medicine, Soonchunhyang University, 657 Hannam-dong, Youngsan-gu, Seoul, 140-743, Korea Tel: 82-2-709-9056, Fax: 82-2-796-3682, E-mail: schsbj@hosp.sch.ac.kr

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Study Design

A retrospective study to evaluate the results of posterior lumbar interbody fusion (PLIF) using titanium cages filled with morselized local bone.

Objective

To verify the clinical and radiological results of the PLIF procedure using rectangular titanium cages filled with morselized local bone.

Summary and literature Review

Stabilization of the spine can be achieved by interbody arthrodesis through the posterior approach. However many significant problems including bone graft collapse, resorption, nonunion, and iliac donor site morbidity caused by the classic PLIF procedure need to be solved. The use of local bone and a titanium cage might be a solution.

Materials and method

Fifty-nine patients(average age at surgery, 51.3 years), who underwent surgery for degenerated low back disease, were enrolled in this study. The average followup duration was 19.9 months. The radiological fusion status, intervertebral disc heights, visual analogue scales, clinical outcomes were evaluated.

Results

Forty-three (73%) patients were classified as complete-union, 16 (27%) patients as probable-union, and no patients were classified as non-union. The average intervertebral disc height increased by 3.7 mm at immediate postoperatively, and the average subsidence was 1.1 mm at the final followup. The average visual analogue scale decreased from 5.5 to 1.4 for back pain and from 6.6 to 0.8 for radicular pain. Nineteen (32%) and 28 (48%) patients were classified as excellent and good, respectively, according to clinical outcome assessment by Kim and Kim criteria. The complications encountered were a dural tear in 8 patients, partial root injury in 1, and upper adjacent segment instability during followup in 2.

Conclusion

PLIF using titanium cages filled with morselized local bone has the advantages of maintaining an intervertebral disc height, immediate stability, and the avoidance of donor site morbidity. However, longer-term results are needed, because the followup period of this study was relatively short

Keywords: Posterior lumbar interbody fusion, Titanium cage, Morselized local bone, Pedicle screw

REFERENCES

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5). Brantigan JW, Steffee AD, Geiger JM. A carbon fiber implant to aid interbody fusion. Mechanical testing. Spine. 1991; 16:S277–285.

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9). Kim NH, Kim DJ. Anterior interbody fusion for spondylolisthesis. Orthopaedics. 1991; 14(10):1069–1076.

10). Lin PM. Posterior lumbar interbody fusion: Complications and pitfalls. Clin Orthop. 1985; 193:90–102.

11). Hutter CG. Posterior intervertebral fusion. A 25-year study. Clin Orthop. 1983; 179:86–96.

12). Lin PM, Cautilli RA, Joyce MF. Posterior lumbar interbody fusion. Clin Orthop. 1983; 180:154–168.

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14). Arai Y, Takahashi M, Kurosawa H, Shitoto K. Com-parative study of iliac bone graft and carbon cage with local bone graft in posterior lumbar interbody fusion. J Orthop Surg. 2002; 10(1):1–7.

15). Miura Y, Imagama S, Yoda M, Mitsuguchi H, Kachi H. Is local bone viable as a source of bone graft in posterior lumbar interbody fusion. Spine. 2003; 28:2386–2389.

16). Hashimoto T, Shigenobu K, Kanayama M, et al. 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. 2002; 27:258–262.

Figures and Tables%

Fig. 1.

Changes of disc height.

Fig. 2.

A 43-year-old male patient with L4 isthmic spondylolisthesis and bilateral L4 radiculopathy. (A) Preoperative lateral view shows moderate anterior slipping of L4, decrease in disc height at L4-5. (B) Lateral view after surgery shows reduction of the slip, restoration of disc height. (C) At 3 year after surgery, lateral radiograph shows solid fusion and maintainance of reduction.

Table 1.

Patient profile

No	Age (years)	Sex	Etiology	F/U (month)	Kim & Kim	fusion	Time (min)	B/L (ml)
1	62	F	spondylolisthesis L3-4, stenosis L3-4-5	36.0	good	complete	210	900
2	68	F	spondylolisthesis L5-S1	33.8	excellent	complete	170	800
3	56	M	stenosis L4-5	18.2	good	complete	150	800
4	38	F	spondylolisthesis L5-S1	24.2	good	complete	210	1400
5	33	M	instability L4-5	23.9	excellent	complete	140	800
6	59	M	stenosis L2-3	25.0	good	complete	215	2000
7	54	F	spondylolisthesis L4-L5	35.6	excellent	complete	125	800
8	45	F	instability L4-5	30.8	good	complete	180	500
9	53	F	spondylolisthesis L4-5	18.4	fair	complete	180	700
10	32	F	instability L4-5	23.8	excellent	complete	140	500
11	60	M	stenosis L4-5-S1	11.6	good	complete	235	1000
12	39	M	instability L4-5	25.7	excellent	complete	150	1000
13	20	M	instability L4-5	25.6	excellent	complete	150	800
14	19	F	instability L4-5	30.6	excellent	complete	160	600
15	58	F	stenosis L3-4-5	22.9	fair	complete	195	850
16	61	F	spondylolisthesis L4-5, stenosis L3-4-5	18.9	good	complete	200	1500
17	37	F	stenosis L5-S1	20.6	excellent\	complete	170	300
18	66	M	stenosis L4-5	26.4	fair	complete	175	400
19	64	F	stenosis L4-5	25.6	fair	complete	150	400
20	52	M	stenosis L4-5	14.0	excellent	probable	210	600
21	51	M	spondylolisthesis L4-5	24.3	good	complete	170	600
22	59	F	stenosis L3-4-5	19.5	good	complete	150	500
23	43	F	stenosis L4-5	12.8	fair	complete	160	800
24	44	F	spondylolisthesis L4-5	24.7	fair	complete	170	600
25	52	F	spondylolisthesis L4-5	25.2	excellent	complete	190	800
26	42	F	spondylolisthesis L4-5	15.2	fair	complete	170	750
27	18	F	spondylolisthesis L4-5	17.9	excellent	probable	170	700
28	63	F	stenosis L4-5	19.9	excellent	probable	160	500
29	32	M	stenosis L3-4	12.4	excellent	probable	220	600
30	50	F	spondylolisthesis L4-5	24.6	excellent	complete	160	700
31	58	F	spondylolisthesis L3-4. stenosis L3-4-5	18.6	good	probable	230	2000
31	60	F	spondylolisthesis L3-4-5	24.8	good	complete	190	1100
33	37	M	spondylolysis L5	23.2	poor	probable	230	600
34	51	F	stenosis L4-5	24.0	good	complete	140	700
35	47	F	spondylolisthesis L4-5	24.3	good	complete	140	650
36	75	M	spondylolisthesis L4-5, stenosis L3-4	18.9	excellent	probable	210	500
37	67	M	stenosis L3-4-5	17.3	fair	probable	225	1500
38	73	F	stenosis L4-5	12.2	good	probable	145	900
39	60	F	stenosis L5-S1	18.5	fair	probable	180	800
40	67	M	stenosis L5-S1	18.4	good	probable	180	500
41	55	F	spondylolisthesis L5-S1	17.2	good	complete	145	1200
42	67	F	stenosis L4-5	14.0	fair	complete	140	500
43	60	F	spondylolisthesis L4-5	17.9	fair	probable	195	2400
44	44	F	spondylolisthesis L4-5	18.6	fair	complete	120	2000
45	52	M	instability L4-5, retrospondylolisthesis L3-4	18.2	good	complete	190	1500
46	57	F	spondylolisthesis L4-5, stenosis L3-4	20.1	poor	probable	180	3000
47	49	F	spondylolisthesis L4-5	18.3	good	probable	140	600
48	43	M	spondylolisthesis L4-5	14.0	excellent	complete	180	1300
49	60	F	spondylolisthesis L4-5	17.9	good	complete	140	900
50	49	M	spondylolisthesis L4-5	17.1	excellent	complete	180	1000
51	62	F	spondylolisthesis L4-5	18.2	good	complete	165	700
52	60	F	spondylolisthesis L3-4, stenosis L4-5	12.2	excellent	complete	250	2400
53	60	F	spondylolisthesis L3-4-5	11.7	good	complete	250	1800
54	49	M	stenosis L4-5	10.9	fair	complete	175	1000
55	66	F	spondylolisthesis L4-5, stenosis L5-S1	12.6	good	complete	255	3100
56	42	F	spondylolisthesis L4-5	12.2	good	complete	145	500
57	38	M	HIVD L4-5 s/p chemonucleolysis	12.2	excellent	probable	120	500
58	66	F	spondylolisthesis L5-S1	11.7	good	probable	210	500
59	55	F	stenosis L4-5-S1	12.2	good	complete	130	500
Ave	51.8			19.9			176.5	980.5

Table 2.

Criteria for Clinical Result (by Kim & Kim)

Excellent	Complete relief of pain in back and lower limbs
	No limitation of physical activity
	Analgesics not used
	Able to squat on the floor
Good	Relief of most pain in back and lower limbs
	Able to return to accustomed employment
	Physical activities slightly limited
	Analgesics used only infrequently
	Able to squat on the floor
Fair	Partial relief of pain in back and lower limbs
	Able to return to accustomed employment with limitation, or return to lighter work
	Physical activities definitely limited
	Mild analgesic medication used frequently
	Mild limitation to squat on the floor
Poor	Little or no relief of pain in back and lower limbs
	Physical activities greatly limited
	Unable to return to accustomed employment
	Analgesic medication used regularly
	Unable to squat on the floor without support

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