Increased incidence of cage migration and nonunion in instrumented transforaminal lumbar interbody fusion with bioabsorbable cages

Smith, Arien J; Arginteanu, Marc S.; Moore, Frank; Steinberger, Alfred A.; Camins, Martin B.

doi:10.3171/2010.3.spine09587

Cited by 41 publications

(26 citation statements)

References 28 publications

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“…Four of the eight patients that exhibited cage migration experienced the adverse event within six months of implantation. Cages that were explanted exhibited moderate plastic deformation, a finding consistent with insufficient material strength discussed previously (Smith et al 2010). In a randomized prospective human study, Jiya et al compared PDLLA lumbar interbody fusion cages to similar non-resorbable PEEK implants and found no significant improvement in clinical outcomes upon 2-year follow-up when compared to preoperative values in the PDLLA group.…”

Section: Thermoplastic Spine Implantssupporting

confidence: 52%

“…Notice the radiolucency of the PEEK cage; only the radiopaque markers inside the implant are visible. Although PEEK implants offer improvements over titanium and titanium alloys, they are still subject to such complications as migration, subsidence, extrusion, wear debris and late foreign body reaction due to the fact that they are permanently implanted (Alexander et al 2002;Smith et al 2010). Furthermore, additional surgeries may be required to remove the constructs.…”

Section: Thermoplastic Spine Implantsmentioning

confidence: 99%

“…While significant clinical success in terms of fusion and appropriately timed resorption has been achieved in animals studies (Toth et al 2002;Thomas et al 2008), subsequent research in humans has indicated poor clinical outcomes (Smith et al 2010;Jiya et al 2011). Particularly, in a prospective cohort study including 81 patients who underwent Transforaminal Lumbar Interbody Fusion (TLIF) surgery with either a resorbable PDLLA cage or a similar nonresorbable carbon fiber cage, Smith et al found significantly higher incidence of non-union and cage migration in PDLLA cages compared to the carbon fiber cages.…”

Section: Thermoplastic Spine Implantsmentioning

confidence: 99%

See 2 more Smart Citations

The Performance Envelope of Spinal Implants Utilizing Thermoplastic Materials

Cook¹,

Yeager²,

Chakraborty³

et al. 2012

Thermoplastic Elastomers

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Section: Thermoplastic Spine Implantssupporting

confidence: 52%

Section: Thermoplastic Spine Implantsmentioning

confidence: 99%

Section: Thermoplastic Spine Implantsmentioning

confidence: 99%

See 1 more Smart Citation

The Performance Envelope of Spinal Implants Utilizing Thermoplastic Materials

Cook¹,

Yeager²,

Chakraborty³

et al. 2012

Thermoplastic Elastomers

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“…However, secondary mobilisation rates in long term, stress shielding, and ensuing failure are its most common complications. According to recent reports, cages appear to have solved neither mechanically nor biologically interbody spinal osteosynthesis either in spinal fracture treatment, in degenerative spine stabilisation, or after correction of deformity [3,36,60,61,65].…”

Section: Interbody Cagesmentioning

confidence: 99%

Surgical treatment of spondylodiscitis. An update

Guerado

Cerván

2012

International Orthopaedics (SICOT)

184

132

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Concept Spondylodiscitis refers to an infection affecting the intervertebral disk, the vertebral body or the posterior arch of the vertebra being aetiologically, pyogenic, granulomatous (tuberculosis, brucellosis, or fungal infection) or parasitic. Diagnosis Spondylodiscitis diagnosis is based on clinical symptoms, a combination of erythrocyte sedimentation rate with C-reactive protein (CRP) tests and, less useful, leukocytosis. Blood culture is also a very cost-effective method of identifying organisms. Plain radiographs are useful, however changes may take several months to appear. Radionuclide tests are currently less used; nevertheless, fluorine-18 fluorodeoxyglucose positron emission tomography (FDG-PET) shows encouraging results particularly when magnetic resonance images (MRI) are unconvincing in the distinction between degenerative changes and infection. MRI with gadolinium enhancement is the choice for image diagnosis. Management Medical management is usually the basis for treatment, alone or in combination with surgery. Surgical approach, either by endoscopy or open, is indicated for biopsy when clinical evolution is unsatisfactory and no micro-organism has been isolated, and also whenever a root, spinal cord or dural compression is seen on MRI; spinal instability or severe deformity are also clear indications for surgical treatment. Less invasive surgery either CT-scan guided or, particularly, by endoscopy has good results. However open surgery is still the standard. The anterior approach allows for anterior disc and bone debridement. The posterior approach is indicated when posterior elements are involved or in the presence of an epidural abscess. Although good results have been claimed, the use of instrumentation in the presence of an infected focus is controversial, as the use of cages or BMPs are.

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“…We have used this method of patient assignment previously. 31 All surgeries were performed together by F.M. and M.A., thus ensuring equivalent technique.…”

Section: Methodsmentioning

confidence: 99%

Increased incidence of pseudarthrosis after unilateral instrumented transforaminal lumbar interbody fusion in patients with lumbar spondylosis

Gologorsky¹,

Skovrlj²,

Steinberger³

et al. 2014

SPI

Self Cite

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Object Transforaminal lumbar interbody fusion (TLIF) with segmental pedicular instrumentation is a wellestablished procedure used to treat lumbar spondylosis with or without spondylolisthesis. Available biomechanical and clinical studies that compared unilateral and bilateral constructs have produced conflicting data regarding patient outcomes and hardware complications. Methods A prospective cohort study was undertaken by a group of neurosurgeons. They prospectively enrolled 80 patients into either bilateral or unilateral pedicle screw instrumentation groups (40 patients/group). Demographic data collected for each group included sex, age, body mass index, tobacco use, and Workers' Compensation/litigation status. Operative data included segments operated on, number of levels involved, estimated blood loss, length of hospital stay, and perioperative complications. Long-term outcomes (hardware malfunction, wound dehiscence, and pseudarthrosis) were recorded. For all patients, preoperative baseline and 6-month postoperative scores for Medical Outcomes 36-Item Short Form Health Survey (SF-36) outcomes were recorded. Results Patient follow-up times ranged from 37 to 63 months (mean 52 months). No patients were lost to follow-up. The patients who underwent unilateral pedicle screw instrumentation (unilateral cohort) were slightly younger than those who underwent bilateral pedicle screw instrumentation (bilateral cohort) (mean age 42 vs 47 years, respectively; p = 0.02). No other significant differences were detected between cohorts with regard to demographic data, mean number of lumbar levels operated on, or distribution of the levels operated on. Estimated blood loss was higher for patients in the bilateral cohort, but length of stay was similar for patients in both cohorts. The incidence of pseudarthrosis was significantly higher among patients in the unilateral cohort (7 patients [17.5%]) than among those in the bilateral cohort (1 patient [2.5%]) (p = 0.02). Wound dehiscence occurred for 1 patient in the unilateral cohort. Reoperation was offered to 8 patients in the unilateral cohort and 1 patient in the bilateral cohort (p = 0.03). The physical component scores of the Medical Outcomes SF-36 outcomes improved significantly for all patients (p < 0.001). Conclusions Transforaminal lumbar interbody fusion with either unilateral or bilateral segmental pedicular instrumentation is an effective treatment for lumbar spondylosis. Because patients with unilateral constructs were 7 times more likely to experience pseudarthrosis and require reoperation, TLIF with bilateral constructs might be the biomechanically superior technique.

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Increased incidence of cage migration and nonunion in instrumented transforaminal lumbar interbody fusion with bioabsorbable cages

Abstract: This study showed an increased incidence of nonunion (18.2%) and postsurgical cage migration (18.2%) in patients undergoing TLIF with biodegradable cages versus carbon fiber implants (0%) (p = 0.006 and 0.007, respectively).

Cited by 41 publications

References 28 publications

The Performance Envelope of Spinal Implants Utilizing Thermoplastic Materials

The Performance Envelope of Spinal Implants Utilizing Thermoplastic Materials

Surgical treatment of spondylodiscitis. An update

Increased incidence of pseudarthrosis after unilateral instrumented transforaminal lumbar interbody fusion in patients with lumbar spondylosis

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