J Korean Orthop Assoc.  2007 Aug;42(4):461-469. 10.4055/jkoa.2007.42.4.461.

The Results of Posterior Lumbar Inter-body Fusion using PEEK Cage andPedicle Screw Stabilization in Degenerative Lumbar Spinal Disorders

• Song KJ
• Lim YJ
• Lee KB

• KMID: 2186507
• DOI: http://doi.org/10.4055/jkoa.2007.42.4.461

Abstract

PURPOSE: To evaluate the results of posterior lumbar interbody fusion (PLIF) using PEEK cage with local laminectomized bone and pedicle screws stabilization in multiple segment degenerative lumbar spinal disorders.
MATERIALS AND METHODS
We performed a retrospective analysis (1 yr follow-up examination) on 152 patients with PLIF using PEEK cage. The 152 patients, were sub-categorized as follows: 1) group A - one level fusion (80 cases), 2) group B - two level fusion (60 cases), and 3) group C - three level fusion (12 cases). We compared each group based on operation time, amount of bleeding, number of complications, sagittal alignment, fusion rate, adjacent segment problems, and evaluation of the clinical result as per the criteria in Kim et al (1991).
RESULTS
For operation time group A took 190.25+/-40.89 min, group B took 230.46+/-39.13 min, and group C took 243.25+/-39.13 min (p=0.08). Furthermore, amount of bleeding for group A was 1,140+/-704 ml, group B was 1,328+/-776 ml, and group C was 1,688+/-756 ml (p=0.07). Consequently, no significant difference was observed between each group. For lumbar lordosis, segmental lordosis, anterior and middle disc height, the last follow-up value was significantly greater than the preoperative value in all three groups. For the adjacent segmental problem, group A had 6 cases, group B had 6 cases, and group C had 2cases. The clinical result revealed a good result in 93.25% for group A, 91.67% for group B, 91.67% for group C. In addition, the fusion rate was 93.75% for group A, 95.00% for group B, and 91.67% for group C. Moreover, the number post-operative complication cases for group A totaled 2 postoperative infections with metal loosening, 5 non-union, and 2 hematomas. Group B had 1 postoperative infection with metal loosening, 3 nonunion, 1 dural tear, and 1 incomplete root injury. Lastly, in group C, 1 complete root injury occurred.
CONCLUSION
A PLIF using PEEK cage with local laminectomized bone and posterior pedicle screw stabilization in multiple segments should be considered to be a useful surgical method as a result of favorable clinical results and a fusion rate similar to the rate of a single segment.

Keyword

Degenerative spinal disorder; Posterior lumbar interbody fusion; PEEK cage

MeSH Terms

Animals
Follow-Up Studies
Hematoma
Hemorrhage
Humans
Lordosis
Retrospective Studies

Figure

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  Fig. 1 A 53-year old female with complaints of lower back painwith bilateral sciatica. (A) Preoperative L-spine plain lateral radiogram shows the Meyerding grade isthmic spondylolisthesis on L4-5. (B) Postoperative L-spine plain lateral radiogram shows PEEK cage filled with autogenous laminectomized bone and pedicle screws stabilzation on L4-5. (C) Postoperative 3 months later, L-spine plain lateral radiogram shows bony bridging between L4 and L5 body and the good visualization of grafted bone. (D) Postoperative follow-up (18 months later), L-spine plain lateral radiogram showing complete bony fusion between the L4 and L5 body.

• 

  Fig. 2 A 58-year old male with complaints of lower back pain with bilateral sciatica. (A) Preoperative L-spine plain lateral radiogram showing the Meyerding grade I degenerative spondylolisthesis on L4-5 and disc space narrowing on L5-S1. (B) Postoperative L-spine plain lateral radiogram showing the PEEK cage filled with autogenous laminectomized bone and pedicle screw stabilzation on L3-4-5. (C) Postoperative 3 months later, L-spine plain lateral radiogram shows bony bridging between L4 and L5 body and the good visualization of grafted bone. (D) Postoperative 22 months later, L-spine plain lateral radiogram shows complete bony fusion between L3 and L4, L4 and L5 body.

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  Fig. 3 64-year old female complaints lower back paint with bilateral sciatica. (A) Preoperative L-spine plain lateral radiogram shows the degenerative retrolisthesis on L2-3 and disc space narrowing on L3-4, L4-5. (B) Postoperative follow-up L-spine plain lateral radiogram shows PEEK cage filled with autogenous laminectomized bone and pedicle screw stabilzation on L2-3-4-5. (C) Postoperative follow-up (3 months later), L-spine plain lateral radiogram shows bony bridging between L4 and L5 body and the good visualization of grafted bone. (D) Postoperative follow-up (20 months later), L-spine plain lateral radiogram shows complete bony fusion between L2 and L3, L3 and L4, L4 and L5 body.

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