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KMID : 0361620080430020143
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Journal of the Korean Orthopaedic Association
2008 Volume.43 No. 2 p.143 ~ p.151
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Comparison of Monosegment Instrumented Posterior Lumbar Interbody Fusion with and without a Metal Cage in Degenerative Spine
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Kim Jin-Hwan
Kim Sung-Soo
Kim Jung-Hoon
Kim Byung-Jik
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Abstract
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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 4.0˚ in the no-cage group and decreased by 3.8˚ 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.
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KEYWORD
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Degenerative lumbar disease, Posterior lumbar interbody fusion, Local bone, Chip bone, Cage
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