Open Access, Peer-reviewed
pISSN 2093-4378
eISSN 2093-4386
    J Korean Soc Spine Surg. 2011 Dec;18(4):230-238. Korean.
    Published online Dec 31, 2011.
    https://doi.org/10.4184/jkss.2011.18.4.230
    © Copyright 2011 Korean Society of Spine Surgery
    Original Article

    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., and Dong-Hun Ham, M.D.
      • Department 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, Email: osdr2815@naver.com
    Received May 02, 2011; Revised October 26, 2011; Accepted November 07, 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 follow-up 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 mid-term 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 post-operative 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 follow-up) 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 follow-up 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, post-operative and final follow-up 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

    Figures

    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.

    Tables

    Table 1
    Demography of Patients

    Table 2
    Changes of disc height, Lumbar lordosis, segmental lordosis, visual analog scale (VAS) and Oswestry disability index (ODI)

    Table 3
    Complications and revision surgery

    References

      1. Brantigan JW, Steffee AD, Geiger JM. A carbon fiber implant to aid interbody fusion. Mechanical testing. Spine (Phila Pa 1976) 1991;16 6 Suppl:S277–S282.
      1. 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;25:1437–1446.
      1. Brodke DS, Dick JC, Kunz DN, McCabe R, Zdeblick TA. Posterior lumbar interbody fusion. A biomechanical comparison, including a new threaded cage. Spine (Phila Pa 1976) 1997;22:26–31.
      1. Csécsei GI, Klekner AP, Dobai J, Lajgut A, Sikula J. Posterior interbody fusion using laminectomy bone and transpedicular screw fixation in the treatment of lumbar spondylolisthesis. Surg Neurol 2000;53:2–6.
      1. Elias WJ, Simmons NE, Kaptain GJ, Chadduck JB, Whitechill R. Complications of posterior lumbar interbody fusion when using a titanium threaded cage device. J Neurosurg 2000;93 1 Suppl:45–52.
      1. Mardjetko SM, Connolly PJ, Shott S. Degenerative lumbar spondylolisthesis. A meta-analysis of literature 1970-1993. Spine (Phila Pa 1976) 1994;19 20 Suppl:2256S–2265S.
      1. Park JT, Shin YS, Yang JH, Seo BG. The fusion rate and clinical effect of PLIF with laminected lamina and spinous process. J Korean Soc Spine Surg 1998;5:79–85.
      1. Schlegel KF, Pon A. The biomechanics of posterior lumbar interbody fusion (PLIF) in spondylolisthesis. Clin Orthop Relat Res 1985;193:115–119.
      1. Shin BJ, Kim GJ, Ha SS, Chung SH, Kwon H, Kim YI. Posterior lumbar interbody fusion using laminar bone block. J Korean Soc Spine Surg 1999;6:110–116.
      1. Steffee AD, Sitkowski DJ. Posterior lumbar interbody fusion and plates. Clin Orthop Relat Res 1988;227:99–102.
      1. Kim KT, Suk KS, Kim JM. Fusion development of interbody fusion cages. J Korean Soc Spine Surg 2001;8:386–391.
      1. Glaser J, Stanley M, Sayre H, Woody J, Found E, Spratt K. A 10-year follow-up evaluation of lumbar spine fusion with pedicle screw fixation. Spine (Phila Pa 1976) 2003;28:1390–1395.
      1. Agazzi S, Reverdin A, May D. Posterior lumbar interbody fusion with cages: an independent review of 71 cases. J Neurosurg 1999;91 2 Suppl:186–192.
      1. Shin BJ, Lee JJ. Results of decompression and internal fixation for spinal stenosis more than 5 year follow-up. J Korean Soc Spine Surg 1998;5:272–277.
      1. Brantigan JW, Neidre A, Toohey JS. The lumbar I/F cage for posterior lumbar interbody fusion with the variable screw placement system: 10-year results of a Food and Drug Administration clinical trial. Spine J 2004;4:681–688.
      1. Fischgrund JS, Mackay M, Herkowitz HN, Brower R, Montgomery DM. 1997 Volvo Award winner in clinical studies Degenerative lumbar spondylolisthesis with spinal stenosis: a prospective, randomized study comparing decompressive laminectomy and arthrodesis with and without spinal instrumentation. Spine (Phila Pa 1976) 1997;22:2807–2812.
      1. Thomsen K, Christensen FB, Eiskjaer SP, Hansen ES, Fruensgaard S, Bunger CE. 1997 Volvo Award winner in clinical studies. The effect of pedicle screw instrumentation on functional outcome and fusion rates in posterolateral lumbar spinal fusion: a prospective, randomized clinical study. Spine (Phila Pa 1976) 1997;22:2813–2822.
      1. Herno A, Saari T, Suomalainen O. The degree of decompressive relief and its relation to clinical outcome in patients undergoing surgery for lumbar spinal stenosis. Spine (Phila Pa 1976) 1999;24:1010–1014.
      1. Cho KJ, Moon KH, Kim MK, et al. Changes of Clinical Outcomes after Decompression and Fusion for Spinal Stenosis during 2-Year Follow-up Periods. J Korean Soc Spine Surg 2003;10:113–118.
      1. Brantigan JW, Neidre A, Toohey JS. The lumbar I/F cage for posterior lumbar interbody fusion with the variable screw placement system: 10-year results of a Food and Drug Administration clinical trial. Spine J 2004;4:681–688.
      1. Bjarke Christensen F, Hansen ES, Laursen M, Thomsen K, Bunger CE. Long-term functional outcome of pedicle screw instrumentation as a support for posterolateral fusion. Spine (Phila Pa 1976) 2002;27:1269–1277.
      1. Rahm MD, Hall BB. Adjacent-Segment Degeneration After Lumbar Fusion with Instrumentation: A Retrospective Study. J Spinal Disord 1996;9:392–400.
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    MeSH Terms
    Animals
    Follow-Up Studies
    Humans
    Ketones
    Lordosis
    Polyethylene Glycols
    Reoperation
    Retrospective Studies
    Metrics
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