J Korean Orthop Assoc.  2008 Apr;43(2):143-151. 10.4055/jkoa.2008.43.2.143.

Comparison of Monosegment Instrumented Posterior Lumbar Interbody Fusion with and without a Metal Cage in Degenerative Spine

• Kim JH
• Kim SS
• Kim JH
• Kim BJ

• KMID: 2106432
• DOI: http://doi.org/10.4055/jkoa.2008.43.2.143

Abstract

PURPOSE: To compare the radiological and clinical results of a local bone graft with those of a single cage in monosegement instrumented posterior lumbar interbody fusion (PLIF) for a spinal stenosis or low-grade spondylolisthesis at the L4-5 level.
MATERIALS AND METHODS
Eighteen patients underwent PLIF using a local bone block and a chip bone without a cage (no-cage group) and 24 patients underwent PLIF using a local bone graft with a single non-threaded metal cage (cage group). All the patients were followed up for a minimum of 2 years. The disc space height, disc lordosis, bone union and clinical results according to Lin's criteria of both groups were reviewed and compared retrospectively.
RESULTS
The disc space heights of the no-cage and cage groups increased by 27% and 44% at the immediate postoperative and 12% and 27% at the latest follow-up, respectively. The cage group showed significantly better restoration of the disc space height (p<0.05). There was a significant loss of restored disc space height in both groups at the postoperative 3 month follow-up (p<0.05). The disc lordosis increased by 4.0degrees in the no-cage group and decreased by 3.8degrees in the cage group at the latest follow-up. In the cage group, the loss of disc lordosis during the follow-up showed a positive correlation with the loss of the anterior disc (r=0.70, p<0.001) and a negative correlation with the initial restoration rate of the disc space height (r=-0.47, p=0.02). The union rate was 83% in the no-cage group and 96% in the cage group without a significant difference (p>0.05). Clinical satisfactory results were obtained in 72% of the no-cage group and 84% of the cage group without a significant difference (p>0.05).
CONCLUSION
Both groups had a significant loss of restored disc space height 3 months after surgery. PLIF using a cage showed better restoration of the disc space height but there was significant loss of disc lordosis during the follow-up. A cage with sufficient height is recommended for restoring the disc space as well as preventing a loss of disc lordosis.

Keyword

Degenerative lumbar disease; Posterior lumbar interbody fusion; Local bone; Chip bone; Cage

MeSH Terms

Animals
Follow-Up Studies
Humans
Lordosis
Spinal Stenosis
Spine
Spondylolisthesis
Transplants

Figure

• 

  Fig. 1 The method for measuring the disc height. (A) The anteroposterior disc height [(D+D')/2] was calculated using the mean value of D and D'. D was defined as the shortest distance between the anterior border of the lower end plate and a line bisecting the upper end plate. D' was defined as the shortest distance between the posterior border of the upper end plate and a line bisecting the lower end plate. (B) The mid-disc height (D) was defined as the shortest distance between the center of a line bisecting the lower end plate and the line bisecting the upper end plate.

• 

  Fig. 2 The lateral radiographs of a sixty-six-year-old male patient suffering from spinal stenosis with disc herniation at L4-5. He was treated with posterior pedicle screw fixation and posterior lumbar interbody fusion using a local bone graft without a cage. (A) The preoperative lateral radiograph showed a disc height of 10.4 mm and disc lordosis of 2.9° at L4-5. (B) The disc height and lordosis improved to 13.1 mm and 9.0° after surgery, respectively. (C) The anteroposterior disc and mid-disc height decreased to 10.9 mm and 12.5 mm, respectively. and disc lordosis decreased slightly to 8.6° at 3 months after surgery. (D) The anteroposterior disc and mid-disc height decreased to 10.4 mm and 10.7 mm, respectively and the disc lordosis decreased to 7.7° at the latest follow-up. Solid bon union was obtained.

• 

  Fig. 3 The lateral radiographs of a fifty-five year old female patient with spinal stenosis at L4-5. She was treated with posterior pedicle screw fixation and posterior lumbar interbody fusion using a local bone graft with a cage. (A) The preoperative lateral radiograph showed an anteroposterior disc height of 12.5 mm, mid-disc height of 12.1 mm and disc lordosis of 8.2° at L4-5. (B) The anteroposterior disc height, mid-disc height and disc lordosis improved to 17.2 mm, 16.9 mm and 11.2° after surgery, respectively. (C) The anteroposterior disc height, mid-disc height and disc lordosis decreased to 14.7 mm, 14.2 mm and 9.5° at 3 months after surgery, respectively. (D) The anteroposterior disc height, mid-disc height and disc lordosis decreased to 14.2 mm, 13.9 mm and 5.5° at the latest follow-up, respectively. Solid bone union was obtained.

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