Fusion Rates and Subsidence of Morselized Local Bone Grafted in Titanium Cages in Posterior Lumbar Interbody Fusion Using Quantitative Three-Dimensional Computed Tomography Scans

Lee, Jae Hyup; Jeon, Do-Whan; Lee, Suk-Jae; Chang, Bong Soon; Lee, Choon-Ki

doi:10.1097/brs.0b013e3181c4baf5

Cited by 69 publications

(55 citation statements)

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“…Lee et al [26] showed an overall fusion rate of 90.0 % with local bone graft in PEEK cages, and of 96.2 % with local bone graft in titanium cages [28], both assessed by CT 1 year after surgery. However, the fused area of local bone inside the cages at regions exposed to endplates was only 58.5 % for PEEK cages and less than 50 % for titanium cages.…”

Section: Discussionmentioning

confidence: 99%

The use of beta-tricalcium phosphate and bone marrow aspirate as a bone graft substitute in posterior lumbar interbody fusion

et al. 2012

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Purpose Due to the disadvantages of iliac crest bone and the poor bone quality of autograft gained from decompression surgery, alternative filling materials for posterior lumbar interbody fusion cages have been developed. b-Tricalcium phosphate is widely used in cages. However, data regarding the fusion rate of b-TCP assessed by computer tomography are currently not available. Materials A prospective clinical trial involving 34 patients (56.7 years) was performed: 26 patients were treated with single-level, five patients double-level and three patients triple-level PLIF filled with b-TCP and bone marrow aspirate perfusion, and additional posterior pedicle screw fixation. Fusion was assessed by CT and X-rays 1 year after surgery using a validated fusion scale published previously. Functional status was evaluated with the visual analogue scale and the Oswestry Disability Index before and 1 year after surgery. Results Forty-five levels in 34 patients were evaluated by CT and X-ray with a follow-up period of at least 1 year. Clinically, the average ODI and VAS for leg and back scores improved significantly (P \ 0.001). CT assessment revealed solid fusion in 12 levels (26.67 %) and indeterminate fusion in 15 levels (34.09 %). Inadequate fusion (non-union) was detected in 17 levels (38.63 %). Conclusion The technique of PLIF using b-TCP yielded a good clinical outcome 1 year after surgery, however, a high rate of pseudoarthrosis was found in this series therefore, we do not recommend b-TCP as a bone graft substitute using the PLIF technique.

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Section: Discussionmentioning

confidence: 99%

The use of beta-tricalcium phosphate and bone marrow aspirate as a bone graft substitute in posterior lumbar interbody fusion

et al. 2012

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“…Weiner et al [26] in their Brantigan ALIF cage series reported 50 %, while Butler [24] reported 10 % in ALIF with a pair of threaded cages, and Lee et al [16], in a study on 54 patients with supplemented posterior lumbar interbody fusion, reported 22 and 28 % subsidence rates in sagittal and coronal planes, respectively.…”

Section: Discussionmentioning

confidence: 99%

“…Beutler et al [24] defined subsidence as a height loss of greater than 2 mm. Lee et al [16] measured the ''endplate destruction length'' on CT in coronal and sagittal planes, which is definitely the most accurate measurement technique published to date.…”

Section: Discussionmentioning

confidence: 99%

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Stand-alone ALIF with integrated intracorporeal anchoring plates in the treatment of degenerative lumbar disc disease: a prospective study on 65 cases

Allain

Delécrin²,

Beaurain³

et al. 2014

Eur Spine J

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Purpose ALIF with cages is expected to restore disc height and stabilize the spine promoting fusion, while avoiding damage attributed to rod-pedicle screw fixation. However, it may be related to an increased risk of fusion failure and subsidence. A prospective study was conducted by five investigators across three centers to confirm performance of a PEEK cage for stand-alone ALIF in the treatment of lumbar degenerative disc disease (DDD). Methods Sixty-five patients, with back ± leg pain, requiring surgery for DDD, were included. Efficacy and safety were evaluated at 6 weeks, 3, 6, and 12 months postoperatively. Fusion and subsidence were assessed through CT-images at 12-month follow-up. Disc height was measured. Clinical outcomes included back and leg pain (VAS), disability (Oswestry Disability Index), Quality of Life (Short-Form 36), and adverse events. Results The fusion and the subsidence rates were 96.3 and 2.0 %, respectively. ALIF surgery restored anterior and posterior disc height compared to baseline. There were no device-related serious adverse events, and no revision surgeries. Clinical outcomes improved significantly through 12-month follow-up. Conclusion Safety and efficacy of this stand-alone cage with integrated intracorporeal plates was confirmed through 12 months for treatment of degenerative conditions. The design of the cage and plates may contribute to the decreased subsidence rate observed.

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“…However, these studies did not clarify the amount of graft material acquired by decompression, although it is one of major factor of successful fusion [15]. There is also a report emphasizing the volume of graft based on the finding that clinical result can be unsatisfactory despite solid radiologic fusion ascribing it to insufficient area of bone bridge for effective load transmission between fused segment [23]. With this point of view, the quality of fusion in PLIF is different according to the quantity of bony bridge between endplates, or fused area ratio, as it is important in the aspect of load transfer and it could be one of factors explaining the well-known mismatch of fusion rate and clinical outcome in PLIF.…”

Section: Discussionmentioning

confidence: 99%

The efficacy of porous hydroxyapatite bone chip as an extender of local bone graft in posterior lumbar interbody fusion

et al. 2011

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Objective To evaluate whether a synthetic bone chip made of porous hydroxyapatite can effectively extend local decompressed bone graft in instrumented posterior lumbar interbody fusion (PLIF). Methods 130 patients, 165 segments, who had undergone PLIF with cages and instrumentation for single or double level due to degenerative conditions, were investigated retrospectively by independent blinded observer. According to the material of graft, patients were divided into three groups. HA group (19 patients, 25 segments): with hydroxyapatite bone chip in addition to autologous local decompressed bone, IBG group (25 patients, 28 segments): with autologous iliac crest bone graft in addition to local decompressed bone and LB group (86 patients, 112 segments): with local decompressed bone only. Radiologic and clinical outcome were compared among groups and postoperative complications, transfusion, time and cost of operation and duration of hospitalization were also investigated. Results Radiologic fusion rate and clinical outcome were not different. Economic cost, transfusion and hospital stay were also similar. But operation time was significantly longer in IBG group than in other groups. There were no lasting complications associated with HA and LB group with contrast to five cases with persisting donor site pain in IBG group. Conclusion Porous hydroxyapatite bone chip is a useful bone graft extender in PLIF when used in conjunction with local decompressed bone.

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Fusion Rates and Subsidence of Morselized Local Bone Grafted in Titanium Cages in Posterior Lumbar Interbody Fusion Using Quantitative Three-Dimensional Computed Tomography Scans

Abstract: The ratio of fused area of local bone inside cages at regions exposed to endplates was <50%, which is insufficient for physiologic load transmission. The authors recommend that additional bone should be grafted into the disc space or new bone bonding interbody spacer should be considered.

Cited by 69 publications

References 18 publications

The use of beta-tricalcium phosphate and bone marrow aspirate as a bone graft substitute in posterior lumbar interbody fusion

The use of beta-tricalcium phosphate and bone marrow aspirate as a bone graft substitute in posterior lumbar interbody fusion

Stand-alone ALIF with integrated intracorporeal anchoring plates in the treatment of degenerative lumbar disc disease: a prospective study on 65 cases

The efficacy of porous hydroxyapatite bone chip as an extender of local bone graft in posterior lumbar interbody fusion

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