Fusion Rates of Intervertebral Polyetheretherketone and Titanium Cages without Bone Grafting in Posterior Interbody Lumbar Fusion Surgery for Degenerative Lumbar Instability

Background Posterior lumbar interbody fusion (PLIF) surgery is a commonly used procedure for degenerative lumbar instability. Locally harvested bone is usually inserted into intervertebral cages to increase fusion rate. The fusion rate without bone application remains unknown. Our aim was to analyze retrospectively the fusion rates of intervertebral polyetheretherketone (PEEK) and titanium cages in PLIF surgery that were implanted without bone grafting using three-dimensional computed tomography (CT) scanning. Material and Methods Forty patients (age 43–83 years) with mono- or bisegmental degenerative instability were included. PEEK cages were used in 28 segments (25 patients), and titanium cages were used in 17 segments (15 patients) undergoing PLIF surgery plus pedicle screws. The primary outcome parameter was radiologic fusion rate measured by CT at follow-up. Secondary parameters included rate of implant failure and adjacent segment disease. Results No difference in mean age between groups was identified (PEEK: 69 ± 10 years; titanium: 62 ± 13 years). Mean follow-up was 39 ± 13 months in PEEK and 24 ± 12 months in the titanium group. Radiologic fusion rate was 32% of operated segments in PEEK and 53% in the titanium group. Screw loosening/adjacent-level disease was observed in 8% and 8% in the PEEK group and in 0% and 7% in the titanium group, respectively. Conclusion Radiologic fusion rates of PEEK and titanium cages without bone grafting is low in PLIF surgery, and therefore bone grafting should be performed if possible. Rate of implant failure and adjacent-level disease remains low despite reduced osseous fusion in the operated segments.

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Differences in standing and sitting spinopelvic sagittal alignment for patients with posterior lumbar fusion: important considerations for the changes of unfused adjacent segments lordosis

BMC Musculoskeletal Disorders ◽

10.1186/s12891-020-03777-2 ◽

2020 ◽

Vol 21 (1) ◽

Author(s):

Zhuoran Sun ◽

Siyu Zhou ◽

Wei Wang ◽

Da Zou ◽

Weishi Li

Keyword(s):

Sagittal Alignment ◽

Lumbar Fusion ◽

Linear Regression Analysis ◽

Posterior Lumbar Interbody Fusion ◽

Sagittal Profile ◽

Adjacent Segment ◽

Sitting Position ◽

Lumbosacral Fusion ◽

Posterior Lumbar Fusion

Abstract Objective This study aimed to describe the changes in spinopelvic sagittal alignment in the sitting position after posterior lumbar fusion, and to identify the factors influencing unfused adjacent segment lordosis. Methods Consecutive patients with lumbar degenerative disease who underwent posterior lumbar interbody fusion between December 2010 and April 2012 were recruited. Lateral full spine radiographs were obtained in the standing, erect sitting, and natural sitting positions. Spinopelvic parameters were measured preoperatively and at the final follow-up. Results The data of 63 patients were analyzed in this study. The average age was 61.6 ± 11.0 years. When changing from standing to sitting at the final follow-up, all spinopelvic sagittal parameters with the exceptions of pelvic incidence and thoracic kyphosis were significantly altered. The most noticeable changes occurred in the natural sitting position, with the spine slumped toward achieving a C-shaped sagittal profile. Multiple linear regression analysis revealed that when changing to a natural sitting position, age and fusion levels reflected the changes in lumbar lordosis (ΔLL), age and lumbosacral fusion reflected the changes in upper residual lordosis (ΔURL). Conclusion The most noticeable changes in spinopelvic sagittal alignment occurred in the natural sitting position after lumbar fusion. Age, fusion levels, and lumbosacral fusion significantly influenced the differences in LL and URL between the standing and natural sitting position. These characteristics should be fully considered when planning spinal realignment surgery and investigating the etiological factors of junctional complications.

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Differences in Standing and Sitting Spinopelvic Sagittal Alignment for Patients with Posterior Lumbar Fusion: Important Considerations for the Changes of Unfused Adjacent Segments Lordosis

10.21203/rs.3.rs-60488/v1 ◽

2020 ◽

Author(s):

Zhuoran Sun ◽

Siyu Zhou ◽

Wei Wang ◽

Da Zou ◽

Weishi Li

Keyword(s):

Sagittal Alignment ◽

Lumbar Fusion ◽

Linear Regression Analysis ◽

Posterior Lumbar Interbody Fusion ◽

Sagittal Profile ◽

Adjacent Segment ◽

Sitting Position ◽

Lumbosacral Fusion ◽

Posterior Lumbar Fusion

Abstract Objective: This study aimed to describe the changes in spinopelvic sagittal alignment in the sitting position after posterior lumbar fusion, and to identify the factors influencing unfused adjacent segment lordosis.Methods: Consecutive patients with lumbar degenerative disease who underwent posterior lumbar interbody fusion between December 2010 and April 2012 were recruited. Lateral full spine radiographs were obtained in the standing, erect sitting, and natural sitting positions. Spinopelvic parameters were measured preoperatively and at the final follow-up. Results: The data of 63 patients were analyzed in this study. The average age was 61.6±11.0 years. When changing from standing to sitting at the final follow-up, all spinopelvic sagittal parameters with the exceptions of pelvic incidence and thoracic kyphosis were significantly altered. The most noticeable changes occurred in the natural sitting position, with the spine slumped toward achieving a C-shaped sagittal profile. Multiple linear regression analysis revealed that when changing to a natural sitting position, age and fusion levels reflected the changes in lumbar lordosis (ΔLL), age and lumbosacral fusion reflected the changes in upper residual lordosis (ΔURL). Conclusion: The most noticeable changes in spinopelvic sagittal alignment occurred in the natural sitting position after lumbar fusion. Age, fusion levels, and lumbosacral fusion significantly influenced the differences in LL and URL between the standing and natural sitting position. These characteristics should be fully considered when planning spinal realignment surgery and investigating the etiological factors of junctional complications.

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Differences in standing and sitting spinopelvic sagittal alignment for patients with posterior lumbar fusion: important considerations for the changes of unfused adjacent segments lordosis

10.21203/rs.3.rs-60488/v2 ◽

2020 ◽

Author(s):

Zhuoran Sun ◽

Siyu Zhou ◽

Wei Wang ◽

Da Zou ◽

Weishi Li

Keyword(s):

Sagittal Alignment ◽

Lumbar Fusion ◽

Linear Regression Analysis ◽

Posterior Lumbar Interbody Fusion ◽

Sagittal Profile ◽

Adjacent Segment ◽

Sitting Position ◽

Lumbosacral Fusion ◽

Posterior Lumbar Fusion

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Outcomes of 2-level posterior lumbar interbody fusion for 2-level degenerative lumbar spondylolisthesis

Journal of Neurosurgery Spine ◽

10.3171/2013.4.spine12651 ◽

2013 ◽

Vol 19 (1) ◽

pp. 90-94 ◽

Cited By ~ 18

Author(s):

Hironobu Sakaura ◽

Tomoya Yamashita ◽

Toshitada Miwa ◽

Kenji Ohzono ◽

Tetsuo Ohwada

Keyword(s):

Lumbar Spine ◽

Clinical Outcome ◽

Interbody Fusion ◽

Sagittal Alignment ◽

Posterior Lumbar Interbody Fusion ◽

Adjacent Segment ◽

Lumbar Interbody Fusion ◽

Single Level ◽

The Mean

Object A systematic review concerning surgical management of lumbar degenerative spondylolisthesis (DS) showed that a satisfactory clinical outcome was significantly more likely with adjunctive spinal fusion than with decompression alone. However, the role of adjunctive fusion and the optimal type of fusion remain controversial. Therefore, operative management for multilevel DS raises more complicated issues. The purpose of this retrospective study was to elucidate clinical and radiological outcomes after 2-level PLIF for 2-level DS with the least bias in determination of operative procedure. Methods Since 2005, all patients surgically treated for lumbar DS at the authors' hospital have been treated using posterior lumbar interbody fusion (PLIF) with pedicle screws, irrespective of severity of slippage, patient age, or bone quality. The authors conducted a retrospective review of 20 consecutive cases involving patients who underwent 2-level PLIF for 2-level DS and had been followed up for 2 years or longer (2-level PLIF group). They also analyzed data from 92 consecutive cases involving patients who underwent single-level PLIF for single-level DS during the same time period and had been followed for at least 2 years (1-level PLIF group). This second group served as a control. Clinical status was assessed using the Japanese Orthopaedic Association (JOA) score. Fusion status and sagittal alignment of the lumbar spine were assessed by comparing serial plain radiographs. Surgery-related complications and the need for additional surgery were evaluated. Results The mean JOA score improved significantly from 12.8 points before surgery to 20.4 points at the latest follow-up in the 2-level PLIF group (mean recovery rate 51.8%), and from 14.2 points preoperatively to 22.5 points at the latest follow-up in the single-level PLIF group (mean recovery rate 55.3%). At the final follow-up, 95.0% of patients in the 2-level PLIF group and 96.7% of those in the 1-level PLIF group had achieved solid spinal fusion, and the mean sagittal alignment of the lumbar spine was more lordotic than before surgery in both groups. Early surgery-related complications, including transient neurological complications, occurred in 6 patients in the 2-level PLIF group (30.0%) and 11 patients in the 1-level PLIF group (12.0%). Symptomatic adjacent-segment disease was found in 4 patients in the 2-level PLIF group (20.0%) and 10 patients in the 1-level PLIF group (10.9%). Conclusions The clinical outcome of 2-level PLIF for 2-level lumbar DS was satisfactory, although surgery-related complications including symptomatic adjacent-segment disease were not negligible.

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The Fate of Bone Graft for Periprosthetic Osteolysis in Total Ankle Arthroplasty

Foot & Ankle Orthopaedics ◽

10.1177/2473011417s000070 ◽

2017 ◽

Vol 2 (3) ◽

pp. 2473011417S0000 ◽

Cited By ~ 1

Author(s):

Yoo Jung Park ◽

Dong-Woo Shim ◽

Yeokgu Hwang ◽

Jin Woo Lee

Keyword(s):

Clinical Outcome ◽

Bone Graft ◽

Bone Grafting ◽

Distal Tibia ◽

Total Ankle Arthroplasty ◽

Implant Failure ◽

Periprosthetic Osteolysis ◽

Aofas Score ◽

Ankle Arthroplasty

Category: Ankle Arthritis Introduction/Purpose: Periprosthetic osteolysis in total ankle arthroplasty (TAA) is a substantial problem. It may cause implant failure and has potential to affect long-term implant survival. To prevent major revisional arthroplasty, it is important to make an early diagnosis of osteolysis and decide an appropriate timing of surgical intervention such as bone graft. We report our experience of bone graft for osteolysis after TAA associated with clinical and radiologic outcome. Methods: Between May 2004 and Oct. 2013, 238 primary TAA were performed on 219 patients. We excluded 37 ankles with follow-up less than 24 months; thus, 201 ankles in 185 patients with mean follow-up of 61.9 (range, 24-130) months were included in the study. Nineteen patients were treated with a total of 21 bone graft procedures for periprosthetic osteolysis after TAA. Of these patients, 12 (57.1%) were males with mean follow-up length after bone graft 35.0 months. Location of osteolysis, bone grafting method and clinical outcome parameters using visual analog scale (VAS), American Orthopaedic Foot and Ankle Society (AOFAS) score were recorded. Results: Radiographs revealed total of 62 osteolysis lesions in 19 patients; 35 (56.5%) distal tibial lesions, 23 (37.0%) talar lesions. Autogenous iliac bone graft was used in 18 procedures (85.7%). The mean scores (and standard deviation) improved for the VAS from 4.8 ± 1.23 points before bone graft to 3.0 ± 0.94 points at the last follow-up (p<0.05); and for the AOFAS score from 76.8 ± 5.9 before bone graft to 84.3 ± 4.5 at the last follow-up (p<0.05). After 21 bone graft procedures, 6 demonstrated detection of newly developed osteolysis. One patient needed a repeat bone graft procedure with cementation after the primary bone grafting due to large cyst on distal tibia. There was no implant failure or major revisions after the bone graft. Conclusion: Bone graft for periprosthetic osteolysis may improve patient’s clinical outcome and give support to the structures surrounding the implant. Bone grafting in optimal timing may also improve implant survivorship. However, further study is needed for the etiology of newly developed painless osteolysis even after the bone graft.

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A Compaction Bone Grafting Technique Leads to Early Bone Fusion in Cases of Posterior Lumbar Interbody Fusion

Operative Neurosurgery ◽

10.1227/neu.0000000000001044 ◽

2015 ◽

Vol 12 (1) ◽

pp. 31-38

Author(s):

Mikinobu Takeuchi ◽

Norimitsu Wakao ◽

Mitsuhiro Kamiya ◽

Atsuhiko Hirasawa ◽

Shuntaro Hanamura ◽

...

Keyword(s):

Bone Grafting ◽

Interbody Fusion ◽

Lumbar Fusion ◽

Posterior Lumbar Interbody Fusion ◽

Psoas Muscle ◽

Lumbar Interbody Fusion ◽

Impaction Bone Grafting ◽

Computed Tomographic ◽

Bone Fusion ◽

Grafting Technique

Abstract BACKGROUND The impaction bone grafting technique is a popular approach for achieving complete bone fusion during hip surgery or total knee arthroplasty. We hypothesized that compaction bone grafting (CBG), a modified version of impaction bone grafting, could be applied to lumbar fusion surgery. OBJECTIVE To compare the bone fusion rates and durations achieved using the CBG technique and a conventional loose bone grafting technique. METHODS We retrospectively reviewed 89 patients who underwent single-level posterior lumbar interbody fusion at the university hospital; 35 other posterior lumbar interbody fusion recipients were excluded due to undergoing multilevel fusion, prior lumbar surgery, trauma, infection, or inadequate computed tomographic data. Computed tomographic-based bone fusion assessments were obtained using the Brantigan, Steffee, and Fraser criteria at 1 and 2 years after surgery. RESULTS The baseline characteristics of the CBG (n = 42) and loose bone grafting (n = 47) groups did not significantly differ. Fusion assessments indicated that significantly superior bone fusion rates were achieved at 1 year after surgery in the CBG group than in the loose bone grafting group (P = .04, χ2 test). However, the bone fusion rates of the 2 groups at 2 years after surgery did not significantly differ (P = .3). A nonsymptomatic surgical complication occurred in the CBG group when a spacer was inserted into the intervertebral space; specifically, the spacer slipped out of the right psoas muscle because a large quantity of compaction bone grafts disrupted the cage's pathway. CONCLUSION In posterior lumbar interbody fusion surgeries, bone fusion was achieved more quickly with the CBG technique than with the conventional technique.

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Novel placement of cortical bone trajectory screws in previously instrumented pedicles for adjacent-segment lumbar disease using CT image-guided navigation

Neurosurgical FOCUS ◽

10.3171/2014.1.focus13521 ◽

2014 ◽

Vol 36 (3) ◽

pp. E9 ◽

Cited By ~ 48

Author(s):

Analiz Rodriguez ◽

Matthew T. Neal ◽

Ann Liu ◽

Aravind Somasundaram ◽

Wesley Hsu ◽

...

Keyword(s):

Cortical Bone ◽

Pedicle Screw ◽

Screw Fixation ◽

Lumbar Fusion ◽

Pedicle Screw Fixation ◽

Adjacent Segment ◽

Average Hospital ◽

Cortical Bone Trajectory ◽

Image Guided

Object Symptomatic adjacent-segment lumbar disease (ASLD) after lumbar fusion often requires subsequent surgical intervention. The authors report utilizing cortical bone trajectory (CBT) pedicle screw fixation with intraoperative CT (O-arm) image-guided navigation to stabilize spinal levels in patients with symptomatic ASLD. This unique technique results in the placement of 2 screws in the same pedicle (1 traditional pedicle trajectory and 1 CBT) and obviates the need to remove preexisting instrumentation. Methods The records of 5 consecutive patients who underwent lumbar spinal fusion with CBT and posterior interbody grafting for ASLD were retrospectively reviewed. All patients underwent screw trajectory planning with the O-arm in conjunction with the StealthStation navigation system. Basic demographics, operative details, and radiographic and clinical outcomes were obtained. Results The average patient age was 69.4 years (range 58–82 years). Four of the 5 surgeries were performed with the Minimal Access Spinal Technologies (MAST) Midline Lumbar Fusion (MIDLF) system. The average operative duration was 218 minutes (range 175–315 minutes). In the entire cohort, 5.5-mm cortical screws were placed in previously instrumented pedicles. The average hospital stay was 2.8 days (range 2–3 days) and there were no surgical complications. All patients had more than 6 months of radiographic and clinical follow-up (range 10–15 months). At last follow-up, all patients reported improved symptoms from their preoperative state. Radiographic follow-up showed Lenke fusion grades of A or B. Conclusions The authors present a novel fusion technique that uses CBT pedicle screw fixation in a previously instrumented pedicle with intraoperative O-arm guided navigation. This method obviates the need for hardware removal. This cohort of patients experienced good clinical results. Computed tomography navigation was critical for accurate CBT screw placement at levels where previous traditional pedicle screws were already placed for symptomatic ASLD.

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Comparison of pedicle screw–based dynamic stabilization and fusion surgery in the treatment of radiographic adjacent-segment degeneration: a retrospective analysis of single L5–S1 degenerative spondylosis covering 4 years

Journal of Neurosurgery Spine ◽

10.3171/2016.4.spine1679 ◽

2016 ◽

Vol 25 (6) ◽

pp. 706-712 ◽

Cited By ~ 5

Author(s):

Yu Han ◽

Jianguang Sun ◽

Chenghan Luo ◽

Shilei Huang ◽

Liren Li ◽

...

Keyword(s):

Pedicle Screw ◽

Interbody Fusion ◽

Posterior Lumbar Interbody Fusion ◽

Adjacent Segment Degeneration ◽

Adjacent Segment ◽

Spinopelvic Parameters ◽

Fusion Surgery ◽

Spinal Stabilization ◽

Pfirrmann Grade

OBJECTIVE Pedicle screw–based dynamic spinal stabilization systems (PDSs) were devised to decrease, theoretically, the risk of long-term complications such as adjacent-segment degeneration (ASD) after lumbar fusion surgery. However, to date, there have been few studies that fully proved that a PDS can reduce the risk of ASD. The purpose of this study was to examine whether a PDS can influence the incidence of ASD and to discuss the surgical coping strategy for L5–S1 segmental spondylosis with preexisting L4–5 degeneration with no related symptoms or signs. METHODS This study retrospectively compared 62 cases of L5–S1 segmental spondylosis in patients who underwent posterior lumbar interbody fusion (n = 31) or K-Rod dynamic stabilization (n = 31) with a minimum of 4 years' follow-up. The authors measured the intervertebral heights and spinopelvic parameters on standing lateral radiographs and evaluated preexisting ASD on preoperative MR images using the modified Pfirrmann grading system. Radiographic ASD was evaluated according to the results of radiography during follow-up. RESULTS All 62 patients achieved remission of their neurological symptoms without surgical complications. The Kaplan-Meier curve and Cox proportional-hazards model showed no statistically significant differences between the 2 surgical groups in the incidence of radiographic ASD (p > 0.05). In contrast, the incidence of radiographic ASD was 8.75 times (95% CI 1.955–39.140; p = 0.005) higher in the patients with a preoperative modified Pfirrmann grade higher than 3 than it was in patients with a modified Pfirrmann grade of 3 or lower. In addition, no statistical significance was found for other risk factors such as age, sex, and spinopelvic parameters. CONCLUSIONS Pedicle screw–based dynamic spinal stabilization systems were not found to be superior to posterior lumbar interbody fusion in preventing radiographic ASD (L4–5) during the midterm follow-up. Preexisting ASD with a modified Pfirrmann grade higher than 3 was a risk factor for radiographic ASD. In the treatment of degenerative diseases of the lumbosacral spine, the authors found that both of these methods are feasible. Also, the authors believe that no extra treatment, other than observation, is needed for preexisting degeneration in L4–5 without any clinical symptoms or signs.

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Pedicle screw fixation for isthmic spondylolisthesis: does posterior lumbar interbody fusion improve outcome over posterolateral fusion?

Journal of Neurosurgery Spine ◽

10.3171/spi.2003.99.2.0143 ◽

2003 ◽

Vol 99 (2) ◽

pp. 143-150 ◽

Cited By ~ 12

Author(s):

Giovanni La Rosa ◽

Alfredo Conti ◽

Fabio Cacciola ◽

Salvatore Cardali ◽

Domenico La Torre ◽

...

Keyword(s):

Interbody Fusion ◽

Lumbar Fusion ◽

Posterior Lumbar Interbody Fusion ◽

Fusion Rate ◽

Pedicle Screw Fixation ◽

Posterolateral Fusion ◽

Lumbar Interbody Fusion ◽

Isthmic Spondylolisthesis ◽

Content Type ◽

Fine Print

Object. Posterolateral fusion involving instrumentation-assisted segmental fixation represents a valid procedure in the treatment of lumbar instability. In cases of anterior column failure, such as in isthmic spondylolisthesis, supplemental posterior lumbar interbody fusion (PLIF) may improve the fusion rate and endurance of the construct. Posterior lumbar interbody fusion is, however, a more demanding procedure and increases costs and risks of the intervention. The advantages of this technique must, therefore, be weighed against those of a simple posterior lumbar fusion. Methods. Thirty-five consecutive patients underwent pedicle screw fixation for isthmic spondylolisthesis. In 18 patients posterior lumbar fusion was performed, and in 17 patients PLIF was added. Clinical, economic, functional, and radiographic data were assessed to determine differences in clinical and functional results and biomechanical properties. At 2-year follow-up examination, the correction of subluxation, disc height, and foraminal area were maintained in the group in which a PLIF procedure was performed, but not in the posterolateral fusion—only group (p < 0.05). Nevertheless, no statistical intergroup differences were demonstrated in terms of neurological improvement (p = 1), economic (p = 0.43), or functional (p = 0.95) outcome, nor in terms of fusion rate (p = 0.49). Conclusions. The authors' findings support the view that an interbody fusion confers superior mechanical strength to the spinal construct; when posterolateral fusion is the sole intervention, progressive loss of the extreme correction can be expected. Such mechanical insufficiency, however, did not influence clinical outcome.

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Comparison of Incidence of Adjacent Segment Pathology between Anterior Lumbar Interbody Fusion and Transforaminal Lumbar Interbody Fusion Treatments for Lumbosacral Junction

Tomography ◽

10.3390/tomography7040072 ◽

2021 ◽

Vol 7 (4) ◽

pp. 855-865

Author(s):

Po-Kuan Wu ◽

Meng-Huang Wu ◽

Cheng-Min Shih ◽

Yen-Kuang Lin ◽

Kun-Hui Chen ◽

...

Keyword(s):

Interbody Fusion ◽

Medical Center ◽

Lumbar Fusion ◽

Transforaminal Lumbar Interbody Fusion ◽

Adjacent Segment ◽

Lumbar Interbody Fusion ◽

Lumbosacral Junction ◽

The Mean ◽

Anterior Interbody Lumbar Fusion

This research compared the incidence of adjacent segment pathology (ASP) between anterior interbody lumbar fusion (ALIF) treatment and transforaminal lumbar interbody fusion (TLIF) treatment. Seventy patients were included in this retrospective study: 30 patients received ALIF treatment, and 40 patients received TLIF treatment at a single medical center between 2011 and 2020 with a follow-up of at least 12 months. The outcomes were radiographic adjacent segment pathology (RASP) and clinical adjacent segment pathology (CASP). The mean follow-up period was 42.10 ± 22.61 months in the ALIF group and 56.20 ± 29.91 months in the TLIF group. Following single-level lumbosacral fusion, ALIF is superior to TLIF in maintaining lumbar lordosis, whereas the risk of adjacent instability in the ALIF group is significantly higher. Regarding ASP, the incidence of overall RASP and CASP did not differ significantly between ALIF and TLIF groups.

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