Kyung-Jin Song; Kwang-Bok Lee; Dong-Hun Ham

doi:10.4184/jkss.2011.18.4.230

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Song, Lee, and Ham: Efficacy of Posterior Lumbar Interbody Fusion using PEEK Cage and Pedicle Screw Stabilization in Degenerative Lumbar Spinal Disorders - Minimum 3 Years Follow up Results –

Original Article

Journal of Korean Spine Surg 2011;18(4):230-238.

Published online: 21 December 2011

DOI: https://doi.org/10.4184/jkss.2011.18.4.230

Efficacy of Posterior Lumbar Interbody Fusion using PEEK Cage and Pedicle Screw Stabilization in Degenerative Lumbar Spinal Disorders - Minimum 3 Years Follow up Results –

Kyung-Jin Song, M.D., Kwang-Bok Lee, M.D., Dong-Hun Ham, M.D.

Departments of Orthopedic Surgery, Chonbuk National University Medical School, Research Institute of Clinical Medicine, Chonbuk National University Hospital, Jeonju, Korea

Corresponding author: Kwang-Bok Lee, M.D. Department of Orthopedic Surgery, Chonbuk University Hospital 634-18, Keum Am-dong, Dukjin-gu, Jeonju, Chonbuk, 561-712, Korea TEL: 82-63-250-1760, FAX: 82-63-271-6538 E-mail: osdr2815@naver.com

Received 2 May 2011 Revised 26 October 2011 Accepted 7 November 2011

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.

Objectives

To evaluate the three-plus year followup results of patients who underwent posterior lumbar interbody fusion with PEEK cage and pedicle screw fixation for lumbar degenerative disease.

Summary of Literature Review

There are few previous reports addressing posterior lumbar interbody fusion using PEEK cage with midterm follow up periods.

Materials and Methods

260 patients who underwent posterior lumbar interbody fusion with PEEK cage and pedicle screw fixation for lumbar degenerative disease were enrolled. We classified patients into three groups according to their fusion level: group A (n=151) had one-level fusion, and group B (n=91) had two-level fusion, and group C (n=18) had three-level fusion. Clinical outcomes were evaluated by pre- and postoperative Visual analogue scale (VAS) scores, the Oswestry Disability Index (ODI), and complication and reoperation rates. Radiologic outcomes were measured by the fusion rate, sagittal alignment, disc height and changes.

Results

VAS (pre-operative to final followup) changed from 7.62±2.03 (5-10) to 3.19±1.94 (1-8) in group A, from 6.83±2.28(4-9) to 4.51±2.18(2-9) in group B and from 7.17±2.46 (5-10) to 4.63±1.97(1-9) in group C. Final followup ODI also decreased in group A (17.6±8.56%), group B (15.4±5.46%) and group C (24.7±7.46%). This corresponds to scores of 94.7% in group A, 92.3% in group B and 94.4% in group C. There were significant differences between preoperative, postoperative and final followup lumbar lordosis [p=0.042(group A), 0.036(group B), 0.045(group C)], segmental lordosis [p=0.036(group A), 0.039(group B), 0.047(group C)]. Reoperation was performed in patients 8 group A, 4 group B, and 1 group C, and there is no significant diffrence between groups. Adjacent segmental change was found in all reoperation patients, but showed no correlation with clinical results.

Conclusions

Posterior lumbar interbody fusion with PEEK cage and pedicle screw fixation in lumbar degenerative disease showed excellent clinical results and fusion rates, regardless of patient fusion levels.

Keywords: Lumbar degenerative disease, Posterior lumbar interbody fusion, Pedicle screw, PEEK cage

REFERENCES

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Figures and Tables%

Fig. 1.

A 69-year-old female presented with back pain, sciatica and neurogenic claudication.(A) Plain lateral radiograph shows degenerative changes on L4-5 lumbar disc space.(B) T2-weighted MRI(sagittal, axial view) shows that dural sac was compressed by extruded disc material and hypertrophied ligamentum flavum on L4-5. (C) Postoperative radiograph shows posterior lumbar interbody fusion with PEEK cage and pedicle screw fixation on L4-5. (D) 3 years after surgery, radiograph shows solid fusion mass on L4-5.

Fig. 2.

A 61-year-old female presented with back pain and sciatica.(A) Plain lateral radiograph shows degenerative changes and isthmic spondylolisthesis on L4-5 lumbar disc space.(B) T2-weighted MRI(sagittal, axial view) shows spinal stenosis and on L3-4 and L4-5. (C) Postoperative radiograph shows posterior lumbar interbody fusion with PEEK cage and pedicle screw fixation on L3-4 and L4-5. (D,E) 2 years after surgery, radiograph shows adjacent segmental degeneration on L1-2 and L2-3.(F) Revision surgery was performed.

Table 1.

Demography of Patients

	Group A	Group B	Group C
Case(No)	151	91	18
Sex(M:F)	67:84	38:53	7:11
Age(years)	58.73±8.13	61.24±6.51	64.47±9.08
Preoperative Diagnosis
LSS ^*	101	64	16
SLT ^†	25	7	0
LSS with SLT	7	19	2
HLD ^‡	18	1	0

^∗ LSS: Lumbar spinal stenosis,

^† SLT: Spondylolisthesis,

^‡ HLD: Herniated lumbar disc

Table 2.

Changes of disc height, Lumbar lordosis, segmental lordosis, visual analog scale (VAS) and Oswestry disability index (ODI)

	Group	Preop	Postop	Postop 1 years	Postop 2 years	Last FU	p-value (Preop vs. Last FU)
Disc height (mm)	A	9.12±2.87	14.29±3.16	14.03±2.49	13.13±2.95	12.61±3.71	0.026
	B	11.39±3.47	16.09±2.28	15.43±2.39	14.09±4.02	14.01±2.96	0.037
	C	10.26±3.87	15.01±2.69	13.73±2.51	13.48±3.27	13.11±2.31	0.045
P-value between groups	0.37
Lumbar lordosis	A	36.32±12.28°	45.27±10.61°	43.81±9.38°	42.72±11.05°	41.86±7.93°	0.042
	B	31.58±10.15°	40.73±9.64°	39.27±10.22°	38.97±10.36°	38.17±8.43°	0.036
	C	33.49±11.63°	44.73±9.34°	42.86±7.24°	41.03±9.03°	39.51±10.39°	0.045
P-value between groups	0.42
Segmental lordosis	A	10.27±3.15°	16.38±2.37°	16.01±2.52°	15.38±3.63°	14.78±2.03°	0.036
	B	19.76±4.15°	26.67±4.72°	25.19±3.82°	25.04±3.15°	24.43±3.39°	0.039
	C	25.48±6.28°	33.73±5.83°	33.28±6.03°	31.81±6.73°	31.09±5.54°	0.047
P-value between groups	0.55
VAS	A	7.62±2.03	4.12±1.87	3.15±2.16	3.24±2.01	3.19±1.94	0.031
	B	6.83±2.28	5.37±2.52	4.71±1.97	4.25±2.09	4.51±2.18	0.039
	C	7.17±2.46	4.72±2.84	4.25±2.16	4.17±2.37	4.63±1.97	0.048
P-value between groups	0.24
ODI	A	51.5±10.24%	29.4±8.25%	20.5±7.62%	18.2±8.05%	17.6±8.56%	0.03
	B	59.8±9.37%	32.8±8.14%	19.8±8.49%	16.9±6.36%	15.4±5.46%	0.042
	C	67.3±12.83%	39.3±10.26%	30.8±9.48%	27.8±8.41%	24.7±7.46%	0.048
P-value between groups	0.17

Table 3.

Complications and revision surgery

	A (n=151)	B (n=91)	C (n=18)	P-value*
Screw loosening	4	2	0	Not Available
Pseudarthrosis	8	7	1	0.391
Hematoma	2	0	0	Not Available
Dural tear	0	1	0	Not Available
Root injury	0	1	1	Not Available
Adjacent level degeneration	28	12	3	0.547
Revision	8	4	1	1.000

^∗ Fisher's exact test

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