Lumbar-sacral fusion by a combined approach using interbody PEEK cage and posterior pedicle-screw fixation: Clinical and radiological results from a prospective study

Object Transforaminal lumbar interbody fusion (TLIF) is an accepted alternative to circumferential fusion of the lumbar spine in the treatment of degenerative disc disease, spondylolisthesis, and recurrent disc herniation. To maintain disc height while arthrodesis takes place, the technique requires the use of an interbody spacer. Although titanium cages are used in this capacity, the two most common spacers are polyetheretherketone (PEEK) cages and femoral cortical allografts (FCAs). The authors compared the clinical and radiographic outcomes of patients who underwent TLIF with pedicle screw fixation, in whom either a PEEK cage or an FCA was placed as an interbody spacer. Methods The charts and x-ray films obtained in 39 patients (age range 33–68 years, mean 44.7 years) who underwent single-level TLIF between October 2001 and April 2004 and in whom either a PEEK cage (18 patients) or FCA (21 patients) was placed as an interbody spacer were evaluated in a retrospective study. Radiological outcome was based on fusion rate and a comparison of the initial postoperative lordotic angle on standing lateral radiographs with that at long-term follow up (mean follow up 15.1 months, minimum 12 months). To control for variations in radiographic magnification, the authors used lordotic angle as an indirect measure of disc space height. Clinical outcome was assessed using the Oswestry Disability Index (ODI). There were no major complications in either group. Radiographically documented fusion occurred in all patients in the PEEK group and 95.2% of those in the FCA group. Pseudarthrosis developed in one patient in the FCA group, and this patient underwent additional surgery. In both groups, the mean lordotic angle changed by less than 2.20° during the postoperative period, and the mean postoperative ODI score was more than 40 points lower than the mean preoperative score. There was no significant difference between the two groups in mean change in lordotic angle (p = 0.415) and mean change in ODI score (p = 0.491). Conclusions Both PEEK cages and FCAs are highly effective in promoting interbody fusion, maintaining postoperative disc space height, and achieving desirable clinical outcomes in patients who undergo TLIF with pedicle screw fixation. The advantages of PEEK cages include a lower incidence of subsidence and their radiolucency, which permits easier visualization of bone growth.

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Silicon Matrix Calcium Phosphate as a Bone Substitute: Early Clinical and Radiological Results in a Prospective Study With 12-Month Follow-up

The International Journal of Spine Surgery ◽

10.1016/sasj-2007-0122-rr ◽

2008 ◽

Vol 2 (2) ◽

pp. 62-68

Author(s):

Luiz Pimenta ◽

Carlos Fernando Arias Pesántez ◽

Leonardo Oliveira

Keyword(s):

Calcium Phosphate ◽

Prospective Study ◽

Bone Substitute ◽

Silicon Matrix ◽

Radiological Results ◽

Clinical And Radiological Results ◽

A Prospective Study

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A Prospective Study on the Feasibility, Safety, and Efficacy of a Modified Technique to Augment the Strength of Pedicle Screw in Osteoporotic Spine Fixation

Asian Spine Journal ◽

10.31616/asj.2019.0211 ◽

2020 ◽

Vol 14 (3) ◽

pp. 357-363 ◽

Cited By ~ 3

Author(s):

Vikas Tandon ◽

Kalyan Kumar Varma Kalidindi ◽

Sandesh Pacha ◽

Mohd Rafiq Bhat

Keyword(s):

Prospective Study ◽

Pedicle Screw ◽

Pedicle Screws ◽

Standard Of Care ◽

Pedicle Screw Fixation ◽

Cement Augmentation ◽

Modified Technique ◽

A Prospective Study ◽

Spine Fixation

Study Design: Prospective case study.Purpose: Osteoporotic spine fixation by pedicle screw instrumentation is complicated by screw loosening, migration, or pullout with rates of up to 62% documented in the literature. Contemporary solutions have not adequately addressed these complications. We propose a modified surgical technique of cement augmentation with bicortical pedicle screw fixation to address the issue related to implant failure in osteoporotic spine.Overview of Literature: Zindrick and his colleagues described a “windshield wiper” effect owing to the shift of center of rotation to the distal tip of the screw in the bicortical purchase of screws. An increase in pullout strength from 119% to 250% with polymethyl methacrylate augmentation has been documented in the literature. This technique has not been described in the literature.Methods: A prospective study was conducted with 40 patients who underwent surgery by the modified technique. Intraoperative and postoperative complications directly related to the procedure were assessed. Improvement in pain and functional status were assessed. Follow-up radiographs were assessed to check for appreciable screw migration, loosening, or pullout.Results: This technique was used in inserting 364 screws in 40 patients. We did not encounter any difficulty in inserting the screws. A total of 19 screws failed to breach the anterior cortex owing to an error in measurement. There were no complications during the procedure in any of the patients, and the postoperative period was uneventful. The mean follow-up period was 18 months. There were two patients in whom proximal junctional failure with kyphosis was noted during follow-up, who were surgically managed by extension of the fixation levels.Conclusions: Bicortical fixation with cement augmentation is a technically feasible, safe, and effective technique to augment the strength of pedicle screws in osteoporotic spine fixation. It has the potential to be established as a standard of care in osteoporotic spine fixation.

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A comparison of long-term outcomes of translaminar facet screw fixation and pedicle screw fixation: a prospective study

Journal of Neurosurgery Spine ◽

10.3171/spi-07/09/287 ◽

2007 ◽

Vol 7 (3) ◽

pp. 287-292 ◽

Cited By ~ 18

Author(s):

Jayshree Tuli ◽

Sagun Tuli ◽

Marc E. Eichler ◽

Eric J. Woodard

Keyword(s):

Prospective Study ◽

Pedicle Screw ◽

Screw Fixation ◽

Pedicle Screw Fixation ◽

Long Term Outcomes ◽

Time To Surgery ◽

Significant Difference ◽

The Mean ◽

Mean Time

Object In this paper, the authors compare the long-term outcomes of translaminar facet screw fixation (TFSF) and pedicle screw fixation (PSF) in the treatment of degenerative lumbosacral disease. Methods This prospective analytical study was performed to compare the long-term outcomes of TFSF and PSF for degenerative lumbosacral disease. Outcomes were defined as the need for reoperation for the development of a nonunion, end-fusion degeneration, or for explantation of hardware. Results A total of 77 patients were analyzed. Thirty-seven patients underwent PSF and 40 received TFSF. Twenty-three of the 77 patients required a reoperation: 13 (32.5%) of the 40 patients in the TFSF group and 10 (27%) of the 37 the patients in the PSF group. The overall mean time to reoperation (regardless of outcome) was 4.05 years. For patients in the TFSF group the mean time to reoperation was 2.94 years, whereas it was 4.35 years in the PSF group (p = 0.34). Nonunion was noted in seven of the 40 patients in the TFSF group and one of 37 in the PSF group. The mean time to surgery for nonunion for patients in the TFSF group was 3.46 years and for those in the PSF group it was 6.27 years (p = 0.04). Surgery for end-fusion degeneration was performed in two patients in the TFSF group and five in the PSF group (p = 0.43). Explantation of hardware was performed in two patients with TFSF and four patients with PSF. Multivariable analysis revealed a statistically significant difference in the time to surgery for nonunion between PSF and TFSF (p = 0.048), with a hazard ratio of 0.097 (95% confidence interval 0.01–0.98). Conclusions Findings from the current prospective study suggest that there is an increased risk of requirement for a reoperation for nonunion among TFSF cases compared with PSF cases.

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