Clinico-radiological profile of indirect neural decompression using cage or auto graft as interbody construct in posterior lumbar interbody fusion in spondylolisthesis: Which is better?

Abstract

Study design:A prospective clinical study of posterior lumbar interbody fusion in grade I and II degenerative spondylolisthesis was conducted between Mar 2007 and Aug 2008.Purpose:The objective was to assess the clinicoradiological profile of structural v/s nonstructural graft on intervertebral disc height and its consequences on the low back pain (LBP) assessed by Visual analog score (VAS) score and oswestry disability index (ODI) . This study involved 28 patients.Inclusion criteria:Age of 30–70 years, symptomatic patient with disturbed Activities of daily living (ADL), single-level L4/L5 or L5/S1 grade I or grade II degenerative spondylolisthesis.Exclusion criteria:Patients with osteoporosis, recent spondylodiscitis, subchondral sclerosis, visual and cognitive impairment and all other types of spondylolisthesis. All the patients underwent short-segment posterior fixation using CD2 or M8 instrumentation, laminectomy discectomy, reduction and distraction of the involved vertebral space. In 53.5% (n = 15) of the patients, snugly fitted local bone chips were used while in 46.4% (n = 13) of the patients, cage was used. Among the cage group, titanium cage was used in nine (32.1%) and PEEK cages were used in four (14.2%) patients. In one patient, a unilateral PEEK cage was used. The mean follow-up period was 24 months. Among the 28 patients, 67.8% (n = 19) were females and 32.14% (n = 9) were males. 68.24% (n = 18) had L4/L5 and 35.71% (n = 10) had L5/S1 spondylolisthesis. 39.28% (n = 11) were of grade I and 60.71% (n = 17) were of grade II spondylolisthesis.Conclusions:There was a statistically significant correlation (P < 0.012 and P < 0.027) between the change in disc height achieved and the improvement in VAS score in both the graft group and the cage group. The increment in disc height and VAS score was significantly better in the cage group (2 mm ± SD vis-a-vis 7.2 [88%]) than the graft group (1.2 mm ± SD vis-a-vis 5 [62 %]).

Comparison of fusion rate and clinical results between CaO-SiO2-P2O5-B2O3 bioactive glass ceramics spacer with titanium cages in posterior lumbar interbody fusion

“…The role of a cage or intervertebral spacer in PLIF surgery is to prevent foraminal stenosis [23] by maintaining intervertebral stability at the initial stage of insertion [24], facilitating intervertebral fusion, and maintaining disc height [24,25]. In the present study, the authors aimed to compare the efficacy and safety of CaO-SiO 2-P2O5-B2O3 glass ceramics spacer, including radiological and clinical results, with those of the titanium cage when inserted between L1 and S1 in patients with lumbar degenerative disease who required onelevel PLIF.…”

Effects of Lordotic Angle of a Cage on Sagittal Alignment and Clinical Outcome in One Level Posterior Lumbar Interbody Fusion with Pedicle Screw Fixation

“…This could be attributable to the lordotic angles of cages where cage shapes make incomplete contact with the vertebral endplate due to an anatomically concave structure. Since the original segmental lordotic angle of lumbar spine is over 10° [ 18 , 19 ], all cages with angles of 4° and 8° are not sufficient to have a significant impact in anatomical lordotic angles [ 20 ]. Similar to the results of some studies, different cage designs such as horizontal cylinder type and open box type do not influence sagittal alignment during the PLIF [ 21 ].…”

A comparative study between local bone graft with or without cages in unilateral posterior lumbar interbody fusion (PLIF): a retrospective study

“…Cage can be easily sterilized and stored, which greatly reduces the risk of diseases transmitted by allogeneic bone transplantation. In the case of vertebral body collapse caused by intervertebral disc degeneration, interbody fusion with cage can effectively share the load of the anterior column of the vertebral body and restore the height of the intervertebral space [21] . Although numerous analyses have con rmed that the use of cage has achieved good clinical results, cage still has many inherent shortcomings.…”

“…However, some people do not agree with this view. Abdul [21] found that the increase of intervertebral disc height and VAS score in the intervertebral fusion cage group was signi cantly better than that in the local bone graft group in the treatment of lumbar degenerative spondylolisthesis( °/ °) with PLIF operation.…”