Comparing the early efficacies of autologous bone grafting and interbody fusion cages for treating degenerative lumbar instability in patients of different ages

Zhong, Huazhang; Tian, Dan; Zhou, Yun; Jing, Juehua; Qian, Jun; Chen, Lei; Zhu, Bin

doi:10.1007/s00264-016-3124-4

Cited by 6 publications

(6 citation statements)

References 29 publications

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“…[ 1 , 2 ] Deng et al [ 3 ] indicated that cages could promote effective clinical and radiographic outcomes when used for degenerative lumbar diseases. Zhong et al [ 4 ] found that the interbody fusion cages can better preserve the intervertebral space and the foramen height than the autologous bone graft. However, intraoperative and postoperative complications are still encountered, as cage migration into the adjacent vertebral bodies and posterior dislocation into the spinal canal are well-known complications.…”

Section: Introductionmentioning

confidence: 99%

Incidence and risk factors of posterior cage migration following decompression and instrumented fusion for degenerative lumbar disorders

Wang

Zhu

et al. 2017

Medicine

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The aim of this study was to explore the incidence and risk factors for posterior cage migration (PCM) following decompression and instrumented fusion for degenerative lumbar disorders, and hope to provide references in decision making and surgical planning for spine surgeons.By retrieving the medical records from January 2011 to December 2015, 286 patients were retrospectively reviewed. According to the occurrence of PCM, patients were divided into 2 groups: PCM group and non-PCM (N-PCM). To investigate risk values for PCM, 3 categorized factors were analyzed statistically: patient characteristics: age, sex, body mass index, bone mineral density, duration of disease, diagnosis, comorbidity, smoke; surgical variables: surgery time, blood loss, surgical strategy, cage morphology, cage size, surgical segment, fusion number, source of bone graft, surgeon experience; radiographic parameters: preoperative lumbar lordosis, correction of lumbar lordosis, preoperative lumbar mobility, preoperative intervertebral height, change of intervertebral height, Modic changes, paraspinal muscle degeneration.PCM was detected in 18 of 286 patients (6.3%) at follow-up. There was no statistically significant difference between the 2 groups in patient characteristics, except diagnosis, as lumbar spondylolisthesis was more prevalent in PCM group than that in N-PCM group. There was no difference between the 2 groups in surgical variables, except cage size and surgeon experience, as size of cage was smaller in PCM group than that in N-PCM group, and the surgeons with less experience (less than 3 years) were more prevalent in PCM group than that in N-PCM group. There was no statistically significant difference between 2 groups in radiographic parameters. Logistic regression model revealed that less than 3 years of surgeons’ experience, small cage size, and lumbar spondylolisthesis were independently associated with PCM.For patients with lumbar spondylolisthesis, they should be fully informed about the risk of PCM before operation. While for spinal surgeons, large cage should be preferred, and careful manipulation should be adopted, especially for new learners with less than 3-year experience of fusion surgery.

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Section: Introductionmentioning

confidence: 99%

Incidence and risk factors of posterior cage migration following decompression and instrumented fusion for degenerative lumbar disorders

Wang

Zhu

et al. 2017

Medicine

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“…For most types of bone graft procedures, autologous bone from the iliac crest has been considered the gold standard because of high bioactivity and lack of immunity reaction. It is reported that successful and rapid lumbar fusion rates with the autogenous iliac crest bone grafts have been reported higher than 90% 24,25 . However, taking too many autogenic bones will definitely lead to donor site morbidity and insufficiency of local bone will lead to poor rate of bone union 24 .…”

Section: Discussionmentioning

confidence: 99%

Acceptable Fusion Rate of Single‐Level OLIF Using Pure Allograft Combined with Posterior Instrumentation through the Wiltse Approach: A 2‐Year Follow‐Up Study

Chen

et al. 2023

Orthopaedic Surgery

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Objective Autogenic bone grafts have shown successful fusion rates in the treatment of degenerative lumbar disorders, but taking too many autogenic bones may result in donor site ischemia or infection. This study aimed to evaluate the outcomes of single‐level oblique lumbar interbody fusion (OLIF) using pure allograft combined with posterior pedicle screw instrumentation through the Wiltse approach. Methods A retrospective case analysis was performed on a series of consecutive patients who received a single‐level OLIF procedure combined with posterior pedicle screw instrumentation through the Wiltse approach between July 1, 2017, and December 31, 2019, in which pure allogenic bone graft was used and filled in the large window of the cage. The patients were followed up as scheduled at 1 day and 3, 6, 12, 24 months after operation. Clinical outcome was assessed by multiple questionnaires, including Oswestry disability index (ODI), Japanese Orthopaedic Association (JOA) score rating system, short form‐36 health survey (SF‐36), and visual analog scale (VAS) for low back pain. Radiographic outcome was evaluated by measuring the parameters such as disc height, lumbar lordosis, and segmental angle on the standard standing lateral radiographs, and the space angle of the fusion level on the dynamic views of the lateral radiographs. Subsidence of the cage and intervertebral fusion status were evaluated on both the radiographic and CT scan images. Results A total of 34 patients were finally included in this study. At 2‐year follow‐up, the VAS for low back pain, ODI, JOA, and SF‐36 scores all had significant improvement (p < 0.001). Substantial increase of anterior and posterior disc heights was observed (p < 0.001). Both lumbar lordosis and segmental angle became larger (p < 0.05). No visible change of the space angle of the fusion level was found on the dynamic views. The 1‐year fusion rate of 73.5% on CT scans proceeded to 82.4% at 2‐year follow‐up. The fusion rate was as high as 91.2% according to Bridwell interbody fusion grading system on radiographic images. The clinical outcomes in patients with incomplete fusion were just as good as those with complete fusion. The six patients with cage subsidence had higher ODI (p < 0.001) and lower JOA (p < 0.001) and SF‐36 PCS (p = 0.011) scores than those without cage subsidence. Conclusion The use of pure allograft in single‐level OLIF resulted in an acceptable fusion rate and satisfactory clinical effect at 2‐year follow‐up. Supplementation of posterior pedicle screw through the minimally invasive Wiltse approach ensured the favorable outcomes both clinically and radiographically.

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“…Intervertebral heights were measured as the average height of the anterior and posterior intervertebral space by lateral X-ray before the surgery, 2 weeks after the surgery and at the last follow-up to evaluate the stability of fixation. 11,12 CT scans were taken at the last follow-up to evaluate the position of the screws and the fusion of the surgical segment.…”

Section: Discussionmentioning

confidence: 99%

A Minimally Invasive Technique Using Cortical Bone Trajectory Screws Assisted by 3D-Printed Navigation Templates in Lumbar Adjacent Segment Degeneration

He¹,

Dong²,

Wei³

et al. 2021

CIA

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Revision surgery for adjacent segment degeneration (ASD) commonly requires exposing and removing the original fixation. To minimize trauma and to reduce the operation time and blood loss, we introduced a minimally invasive lumbar revision technique using cortical bone trajectory (CBT) screws assisted by three-dimensional (3D)-printed navigation templates. Methods: From April 2017 to October 2019, 18 patients with ASD underwent revision surgery with CBT screws assisted by 3D-printed templates in our hospital. All surgical data, including the operation time, blood loss, and incision length, were recorded. We evaluated the clinical efficacy using the visual analog scale (VAS), the Oswestry Disability Index (ODI), and the Japanese Orthopedic Association (JOA) score. X-ray and computed tomography (CT) scans were used to evaluate the stability of CBT screw fixation, the accuracy of screws, and the fusion rate. Results: The mean follow-up was 22.4±4.7 months (12-31 months). The VAS, ODI, and JOA scores were analyzed by SPSS 21.0 and showed significant improvement at 2 weeks and the last follow-up compared with preoperative data (P<0.05). Seventy-six CBT screws were inserted with navigation templates; 2 screws were Grade B, and the other screws were Grade 0 or A. Changes in intervertebral height showed good stability of CBT screw fixation (P>0.05). All the patients exhibited satisfactory fusion results. Conclusion: Revision surgery for ASD with CBT screws assisted by 3D-printed navigation templates has satisfactory clinical efficacy with the advantages of a short operation time, a small incision, and less blood loss.

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Comparing the early efficacies of autologous bone grafting and interbody fusion cages for treating degenerative lumbar instability in patients of different ages

Cited by 6 publications

References 29 publications

Incidence and risk factors of posterior cage migration following decompression and instrumented fusion for degenerative lumbar disorders

Incidence and risk factors of posterior cage migration following decompression and instrumented fusion for degenerative lumbar disorders

Acceptable Fusion Rate of Single‐Level OLIF Using Pure Allograft Combined with Posterior Instrumentation through the Wiltse Approach: A 2‐Year Follow‐Up Study

A Minimally Invasive Technique Using Cortical Bone Trajectory Screws Assisted by 3D-Printed Navigation Templates in Lumbar Adjacent Segment Degeneration

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