Fusion rate after posterior lumbar interbody fusion with carbon fiber implant: 1-year follow-up of 51 patients

Abstract

Problems associated with posterior lumbar interbody fusion (PLIF) have traditionally included the need for donor bone, prolonged healing time of donor bone, the difficulty of cutting precise bony channels, the risk of retropulsion of graft, postoperative collapse of the bone graft, and pseudarthrosis. To avoid these problems a carbon fiber reinforced polymer implant cage has been developed to facilitate interbody fusion. The aim of the present study was to evaluate the technical problems and fusion rate associated with these new device for PLIF. Between April 1991 and December 1993, 65 pairs of these implant cages were sold in Sweden. They were traced to six hospitals, where they had been used in the treatment of 51 patients operated on at a total of 65 levels. All PLIF were supplemented with VSP (Variable Screw Placement) instrumentation. All medical records were evaluated and all patients were examined with plain radiographs taken at least 1 year after surgery. If that investigation did not show a clear fusion they were also evaluated with CT (18 patients, 27 levels). No intraoperative problems with the device have been reported; 44 patients (86%) and 58 levels (89%) achieved successful fusion. All patients bar one maintained their immediately obtained postoperative disc height. CT with 1-mm slices and sagittal reconstruction is most helpful if radiographs are difficult to interpret.

Comparison of instrumented anterior interbody fusion with instrumented circumferential lumbar fusion

“…Kuslich et al [28] reported a 91% fusion rate, 84% pain relief and 91% functional improvement at 24 months' follow-up using the BAK method of lumbar interbody fusion. Other authors [1,2,3,10,16,50,52] have reported more than 70% satisfactory clinical results with instrumented interbody fusion. Our patients had a 72% rate of clinical satisfaction with ALIF and 74% with circumferential fusion (PLIF) using subjective scores, and 79.5% and 80% clinical satisfaction using the Oswestry Disability Index.…”

“…Corticocancellous bonegrafts were used in many of these reported techniques, to achieve anterior fusion [25,30,39]. Postoperative problems like height loss, graft collapse and pseudarthrosis led to the development of carbon-fibre cages [1,52], and titanium rings [26,33] filled with cancellous grafts. The Hartshill horseshoe cage in this study achieves immediate stabilisation, and the screws in the superior and inferior vertebral bodies provide rigid fixation.…”

“…PLIF offers several advantages [1,10,16,50,52]. It restores disc height, the load bearing ability of anterior ligaments and muscles, root canal dimensions, and spinal balance.…”

“…It immobilises the painful degenerate spinal segment, and decompresses the nerve roots. Early results of instrumented PLIF and use of a carbon-fibre cage for interbody fusion have been encouraging [1,3,52].…”

Do autologous growth factors enhance transforaminal lumbar interbody fusion?

“…To reduce the need for harvesting large amounts of autogenous iliac crest bone graft, cages have been developed that function to distract a collapsed intervertebral disc, provide immediate rigidity, and act as a structural anterior column support and bone graft carrier [39]. Unlike bone grafts, there is no risk of graft collapse leading to post-operative loss of correction and pseudarthrosis [38].…”