Skip to main content

Advertisement

Log in

Outcome of single level instrumented posterior lumbar interbody fusion using corticocancellous laminectomy bone chips

  • Original Article
  • Published:
Indian Journal of Orthopaedics Aims and scope Submit manuscript

Abstract

Background: Interbody fusion surgery has been considered by many to be a treatment of choice for instability in lumbar degenerative disc disease. A posterior lumbar interbody fusion (PLIF) has the advantages of spinal canal decompression, anterior column reconstruction, and reduction of the sagittal slips from a single posterior approach. The PLIF using double cage was a standard practice till many studies reported comparable results and lesser complications with single cage. Iliac crest was considered as an appropriate source of bone graft until comparable spinal fusion rates using local bone graft and cage emerged. Till date, there has been no report of corticocancellous laminectomy bone chips alone being used for spinal fusion. In this paper, we present radiologic results of single level instrumented PLIF, where in only corticocancellous laminectomy bone chips were used as a fusion device.

Materials and Methods: It is a retrospective cohort study of 35 consecutive patients, who underwent single level instrumented PLIF surgery, wherein only locally obtained bone chips was used for spinal fusion. The average follow-up was 26 months. The indications for the surgery were as follows: 19 patients had disc herniations, with back pain of instability type, normal disc height on radiology. Ten patients had grade 1 spondylolisthesis, with signifcant back pain and translational instability on radiography. Three patients were redo spine surgeries, and three patients had healed spondylodiscitis with signifcant back pain and instability. All patients were regularly followed up and decision of spinal fusion or no fusion was taken at 2 years using modifed criteria of Lee.

Results: Of total 35 patients, there were 24 males and 11 females, with a mean age of 41 years. There were 16 patients with definitive fusion, 15 patients with probable fusion, 04 patients with possible pseudoarthrosis, and no patient had definitive pseudoarthrosis. The mean time for fusion to occur was 18 months. The average loss of disc height, over 2 year follow up, was only 3 mm in 8 patients. Three patients had a localized kyphosis of more than 3° at the fusion level. The average blood loss was 356 ml and average operating time was 150 min.

Conclusion: Corticocancellous laminectomy bone chips alone can be used as a means of spinal fusion in patients with single level instrumented PLIF. This has got a good fusion rate.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. 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 decompression in spondylolytic spondylolisthesis. Spine (Phila Pa 1976) 1997;22:210–9.

    Article  CAS  Google Scholar 

  2. Sudo H, Oda I, Abumi K, Ito M, Kotani Y, Minami A. Biomechanical study on the effect of five different lumbar reconstruction techniques on adjacent-level intradiscal pressure and lamina strain. J Neuro Surg Spine 2006;5:150–5.

    Article  Google Scholar 

  3. Fogel GR, Toohey JS, Neidre A, Brantigan JW. Is one cage enough in posterior lumbar interbody fusion: A comparison of unilateral single cage interbody fusion to bilateral cages. J Spinal Disord Tech 2007;20:60–5.

    Article  Google Scholar 

  4. Molinari RW, Sloboda J, Johnstone FL. Are 2 cages needed with instrumented PLIF? A comparison of 1 versus 2 interbody cages in a military population. Am J Orthop (Belle Mead NJ) 2003;32:337–43.

    Google Scholar 

  5. Ito Z, Matsuyama Y, Sakai Y, Imagama S, Wakao N, Ando K, et al. Bone union rate with autologous iliac bone versus local bone graft in posterior lumbar interbody fusion. Spine (Phial Pa 1976) 2010;35:E1101–5.

    Article  Google Scholar 

  6. Lee CK, Vessa P, Lee JK. Chronic disabling low back pain syndrome caused by internal disc derangements. The results of disc excision and posterior lumbar interbody fusion. Spine (Phila Pa 1976) 1995;20:356–61.

    Article  CAS  Google Scholar 

  7. Okuyama K, Kido T, Unoki E, Chiba M. PLIF with a titanium cage and excised facet joint bone for degenerative spondylolisthesis in augmentation with a pedicle screw. J Spinal Disord Tech 2007;20:53–9.

    Article  Google Scholar 

  8. Closkey RF, Parsons JR, Lee CK, Blacksin MF, Zimmerman MC. Mechanics of interbody spinal fusion. Analysis of critical bone graft area. Spine (Phila Pa 1976) 1993;18:1011–5.

    Article  CAS  Google Scholar 

  9. Sprit M, Meijers H, Obradov M, Anderson PG. CT density measurement of bone graft within an intervertebral lumbar cage: Increase of hounsfield units as an indicator for increasing bone mineral content. J Spinal Disord Tech 2004;17:232–5.

    Article  Google Scholar 

  10. Carmouche JJ, Molinari RW. Epidural abscess and discitis complicating instrumented posterior lumbar interbody fusion: A case report. Spine (Phila Pa 1976) 2004;29:E542–6.

    Article  Google Scholar 

  11. Adam C, Pearcy M, Mc Combe P. Stress analysis of interbody fusion-finite element modelling of intervertebral implant and vertebral body. Clin Biomech (Bristol, Avon) 2003;18:265–72.

    Article  Google Scholar 

  12. Brantigan JW, Steffee AD, Lewis ML, Quinn LM, Persenaire JM. Lumbar interbody fusion using the Brantigan I/F cage for posterior lumbar interbody fusion and the variable pedicle screw placement system: Two-year results from a Food and Drug Administration investigational device exemption clinical trial. Spine (Phila Pa 1976) 2000;25:1437–46.

    Article  CAS  Google Scholar 

  13. Younger EM, Chapman MW. Morbidity at bone graft donor sites. J Orthop Trauma 1989;3:192–5.

    Article  CAS  Google Scholar 

  14. Gaines RW Jr. The use of pedicle-screw internal fixation for the operative treatment of spinal disorders. J Bone Joint Surg Am 2000;82-A:1458–76.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Sanganagouda S. Patil.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Patil, S.S., Rawall, S., Nagad, P. et al. Outcome of single level instrumented posterior lumbar interbody fusion using corticocancellous laminectomy bone chips. IJOO 45, 500–503 (2011). https://doi.org/10.4103/0019-5413.87117

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.4103/0019-5413.87117

Key words

Navigation