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KMID : 1189320190130020248
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Asian Spine Journal
2019 Volume.13 No. 2 p.248 ~ p.253
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Early Fusion Status after Posterior Lumbar Interbody Fusion with Cortical Bone Trajectory Screw Fixation: A Comparison of Titanium-Coated Polyetheretherketone Cages and Carbon Polyetheretherketone Cages
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Sakaura Hironobu
Ohnishi Atsunori
Yamagishi Akira
Ohwada Tetsuo
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Abstract
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Study Design: Retrospective cohort study.
Purpose: We recently reported that when compared to posterior lumbar interbody fusion (PLIF) using traditional pedicle screw fixation, PLIF with cortical bone trajectory screw fixation (CBT-PLIF) provided favorable clinical outcomes and reduced the incidence of symptomatic adjacent segment pathology, but resulted in relatively lower fusion rates. Since titanium-coated polyetheretherketone (PEEK) cages (TP) could improve and accelerate fusion status after CBT-PLIF, early fusion status was compared between CBT-PLIF using TP and carbon PEEK cages (CP).
Overview of Literature: A systematic review demonstrated that clinical studies at this early stage show similar fusion rates for TP compared to PEEK cages.
Methods: We studied 36 consecutive patients undergoing CBT-PLIF with TP (TP group) and 92 undergoing CBT-PLIF with CP (CP group). On multiplanar reconstruction computed tomography (MPR-CT) at 6 months postoperatively, vertebral endplate cysts (cyst signs) were evaluated and classified as diffuse or local cysts. Early fusion status was assessed by dynamic plain radiographs and MPR-CT at 1 year postoperatively.
Results: The incidences of cyst signs, diffuse cysts, and early fusion rate in the TP and CP groups were 38.9% and 66.3% (p<0.01), 16.7% and 32.6% (p=0.07), and 83.3% and 79.3% (p>0.05), respectively. Combining the two groups, 22 of 36 patients with diffuse cysts had nonunion at 1-year follow-up, compared to only three of 92 patients with local cysts or without cyst signs (p<0.01).
Conclusions: Despite having fewer patients with endplate cysts at 6 months (a known risk factor for nonunion), the TP group had the same fusion rate as the CP group at 1-year follow-up. Thus, TP did not accelerate the fusion process after CBT-PLIF.
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KEYWORD
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Degenerative lumbar spondylolisthesis, Posterior lumbar interbody fusion, Cortical bone trajectory screw technique, Titanium-coated polyetheretherketone cage, Carbon polyetheretherketone cage
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