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Chahlavi A. Reduced Subsidence With PEEK-Titanium Composite Versus 3D Titanium Cages in a Retrospective, Self-Controlled Study in Transforaminal Lumbar Interbody Fusion. Global Spine J 2024:21925682241253168. [PMID: 38780086 DOI: 10.1177/21925682241253168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/25/2024] Open
Abstract
STUDY DESIGN Retrospective Study. OBJECTIVES To compare subsidence and radiographic fusion rates of titanium-surface polyetheretherketone (PEEK-Ti) and 3D-Titanium (3D-Ti) cages, implanted within the same patient concurrently, during multi-level transforaminal lumbar interbody fusions (TLIF). METHODS Forty-eight patients were treated with both PEEK-Ti and 3D-Ti cages during 2- or 3-level TLIF and instrumented posterolateral fusion (108 spinal levels in all). Equivalent bone graft material was implanted within each patient. Radiographic analysis of CT and/or X-ray imaging was performed retrospectively for each spinal level throughout 12-month follow-up period. Fusion was defined as bridging trabecular bone and subsidence was incursion into one/both vertebral bodies >20% cage height. Outcomes were analyzed with Fisher's exact test. RESULTS At 6-months post-operative follow-up, incidence of subsidence was significantly lower for PEEK-Ti cages, with 4.8% subsidence, compared to a 27.9% subsidence rate for 3D-Ti cages (P = .007). Fusion rates were comparable at 100% for PEEK-Ti and 95.5% for 3D-Ti. Results at 12-months showed similar but not statistically significant trends of less subsidence with PEEK-Ti than 3D-Ti cages (14.3% PEEK-Ti, 37.5% 3D-Ti), and similar fusion rates of 100% for PEEK-Ti and 91.7% for 3D-Ti. Thirty-nine out of 48 total patients were available for follow-up at 6 months and 20 patients at 12 months. CT availability at 6 and 12-months was 100% and 90%, respectively. CONCLUSIONS A significantly lower subsidence rate was associated with a PEEK-Ti cage, compared to 3D-Ti, 6 months after TLIF. Results may not be generalized across technologies due to differences in cage designs; additional research studies are warranted.
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Affiliation(s)
- Ali Chahlavi
- St. Vincent's Neurosurgery, Ascension Health Florida, Jacksonville, FL, USA
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Levy AS, Maddy K, Murray A, John DL, Kumar V, Urakov T. Transforaminal lumbar interbody fusion with placement of steerable banana cage: A single-center retrospective analysis of radiographic parameters of success. Radiography (Lond) 2024; 30:163-167. [PMID: 38035428 DOI: 10.1016/j.radi.2023.10.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Revised: 10/16/2023] [Accepted: 10/19/2023] [Indexed: 12/02/2023]
Abstract
INTRODUCTION The transforaminal lumbar interbody fusion (TLIF) is among the most utilized methods for the surgical treatment of lumbar degenerative disc disease. The TLIF has advanced significantly with several iterative changes since its inception in the early 1980s, with the advent of several generations of interbody types, shapes, and materials. Steerable curvilinear interbodies are among the most recent innovations in this space and may offer biomechanical advantages, namely in preservation of lumbar and segmental lordosis. While radiographic parameters have been investigated for other cage shapes and lumbar interbody fusion techniques, no study has investigated postoperative radiographic outcomes specific to TLIFs done with curvilinear interbodies. METHODS This study is a retrospective review of TLIFs performed with curvilinear interbodies between 2019 and 2022 at a single institution. Upright radiographs were obtained preoperatively and at several timepoints postoperatively. Radiographic variables including interspace height and segmental lordosis were collected. RESULTS 26 surgeries with 32 curvilinear interbodies were performed across 3 years. There was significant increase in segmental lordosis at the L4-L5 (p = 0.0183) and L5-S1 levels (p = 0.004) as well as interspace height postoperatively at levels L3-L4 (p = 0.011) and L4-L5 (p = 0.002). Pain as measured with the numeric rating scale significantly improved in the overall cohort postoperatively (p<0.001). CONCLUSIONS TLIF with curvilinear interbody placement increases segmental lordosis and interspace height at the L4-L5 and L5-S1 levels, and increased interspace height at the L3-L4 and L4-L5 levels. Further investigation into additional radiographic parameters is warranted and expanded cohort size would benefit deeper analysis of other spinal levels. IMPLICATIONS FOR PRACTICE As an increasing number of cage designs and materials are brought to market, studies such as this allow for better understanding of cage specific outcomes allowing for better informed device selection.
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Affiliation(s)
- A S Levy
- Department of Neurological Surgery, University of Miami, Miller School of Medicine, 1095 NW 14th Terrace, Miami, FL, 33136, USA
| | - K Maddy
- Department of Neurological Surgery, University of Miami, Miller School of Medicine, 1095 NW 14th Terrace, Miami, FL, 33136, USA
| | - A Murray
- Department of Neurological Surgery, University of Miami, Miller School of Medicine, 1095 NW 14th Terrace, Miami, FL, 33136, USA
| | - D L John
- Department of Neurological Surgery, University of Miami, Miller School of Medicine, 1095 NW 14th Terrace, Miami, FL, 33136, USA
| | - V Kumar
- Department of Neurological Surgery, University of Miami, Miller School of Medicine, 1095 NW 14th Terrace, Miami, FL, 33136, USA
| | - T Urakov
- Department of Neurological Surgery, University of Miami, Miller School of Medicine, 1095 NW 14th Terrace, Miami, FL, 33136, USA.
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Piple AS, Ungurean V, Raji OR, Rowland A, Schlauch A, Kondrashov DG, Hsu K, Zucherman J. An Analysis of a Decade of Lumbar Interbody Cage Failures in the United States: A MAUDE Database Study. Spine (Phila Pa 1976) 2023; 48:1652-1657. [PMID: 36727830 DOI: 10.1097/brs.0000000000004583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 01/04/2023] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN A retrospective case series. OBJECTIVE This study aims to assess the rates of lumbar interbody cage failures based on their material and manufacturer. SUMMARY OF BACKGROUND DATA Perioperative lumbar interbody cage malfunctions are underreported events in the spine literature and may result in complications. Although the Food and Drug Administration ensures the safety of these devices under physiological conditions after implantation, these devices may experience nonphysiological conditions during implantation, which may be overlooked. MATERIALS AND METHODS The MAUDE database was examined for reports of lumbar cage device malfunctions from 2012 to 2021. Each report was categorized based on failure type and implant design. A market analysis was performed by dividing the total number of failures per year for each manufacturer by their approximate yearly revenue from spinal implants in the United States. Outlier analysis was performed to generate a threshold value above which failure rates were defined as greater than the normal index. RESULTS Overall, 1875 lumbar cage malfunctions were identified. Of these, 1230 (65.6%) were cage breakages, 257 (13.7%) were instrument malfunctions, 177 (9.4%) were cage migrations, 143 (7.6%) were assembly failures, 70 (4.5%) were screw-related failures, and 21 (1.1%) were cage collapses. Of the breakages, 923 (74.9%) occurred during insertion or impaction and 97 entries detailed a medical complication or a retained foreign body. Of the migrations, 155 (88.6%) were identified postoperatively, of which 73 (47.1%) detailed complications and 52 (33.5%) required a revision procedure. Market analysis demonstrated that Medtronic, Zimmer Biomet, Stryker, Seaspine, and K2M exceeded the calculated threshold. CONCLUSIONS Lumbar cages with polyether ether ketone core material failed more frequently by breakage, whereas titanium surface cages failed more frequently by migration. Failure rates varied depending on the manufacturer. Most cage breakages identified in the present study occurred intraoperatively during implantation. These findings call for a more detailed Food and Drug Administration evaluation of these intraoperative malfunctions before commercial approval. LEVEL OF EVIDENCE Level 4.
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Affiliation(s)
| | | | - Oluwatodimu R Raji
- The Taylor Collaboration, San Francisco, CA
- Department of Orthopaedic Surgery, SF Orthopaedic Residency Program, St. Mary's Medical Center, San Francisco, CA
| | - Andrea Rowland
- Department of Orthopaedic Surgery, SF Orthopaedic Residency Program, St. Mary's Medical Center, San Francisco, CA
| | - Adam Schlauch
- Department of Orthopaedic Surgery, SF Orthopaedic Residency Program, St. Mary's Medical Center, San Francisco, CA
| | - Dimitriy G Kondrashov
- Department of Orthopaedic Surgery, SF Orthopaedic Residency Program, St. Mary's Medical Center, San Francisco, CA
- SF Spine Surgeons, San Francisco, CA
| | - Ken Hsu
- Department of Orthopaedic Surgery, SF Orthopaedic Residency Program, St. Mary's Medical Center, San Francisco, CA
- SF Spine Surgeons, San Francisco, CA
| | - James Zucherman
- The Taylor Collaboration, San Francisco, CA
- Department of Orthopaedic Surgery, SF Orthopaedic Residency Program, St. Mary's Medical Center, San Francisco, CA
- SF Spine Surgeons, San Francisco, CA
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Peng Q, Yang S, Zhang Y, Liu H, Meng B, Zhao W, Hu M, Zhang Y, Chen L, Sun H, Zhang L, Wu H. Effects of Structural Allograft versus Polyetheretherketone Cage in Patients Undergoing Spinal Fusion Surgery: A Systematic Review and Meta-Analysis. World Neurosurg 2023; 178:162-171.e7. [PMID: 37442540 DOI: 10.1016/j.wneu.2023.07.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 07/04/2023] [Indexed: 07/15/2023]
Abstract
BACKGROUND Inter body spacers have been widely used in patients undergoing spinal fusion surgery; however, it is not clear whether one implant shows superior clinical outcomes compared with the other. This systematic review and meta-analysis comprehensively evaluated the radiologic outcomes and patient-reported outcomes of structural allograft versus polyetheretherketone (PEEK) implants in patients undergoing spinal fusion surgery. METHODS Extensive literature searches were conducted on online databases, including MEDLINE, Embase, Web of Science, Cochrane Central Register of Controlled Trials, and Cochrane Library, until January 2023. The present study adheres to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, and the Newcastle-Ottawa Scale and Cochrane Collaboration Risk of Bias tool were used to assess the quality of the included studies. RESULTS Fifteen studies, encompassing 8020 patients, met the eligibility criteria. The results indicate that structural allografts show a higher fusion rate compared with PEEK implants (odds ratio [OR], 1.88; 95% confidence interval [CI], 1.05-3.37; P =0.03; I2 = 71%). In addition, the structural allograft group also had a lower pseudarthrosis rate (OR, 0.40; 95% CI, 0.20-0.80; P = 0.009; I2 = 75%) and reoperation rate (OR, 0.46; 95% CI, 0.26-0.81; P = 0.007; I2 = 38%). CONCLUSIONS Our systematic review and meta-analysis show that structural allograft has a higher fusion rate compared with PEEK implants in patients undergoing spinal fusion surgery. In addition, structural allograft has a lower pseudarthrosis rate and reoperation rate.
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Affiliation(s)
- Qing Peng
- Department of Orthopedics, Clinical Medical College of Yangzhou University, Yangzhou, China
| | - Sheng Yang
- Department of Orthopedics, Graduate School of Dalian Medical University, Dalian, China
| | - Yu Zhang
- Department of Orthopedics, Clinical Medical College of Yangzhou University, Yangzhou, China
| | - Huanxiang Liu
- Department of Orthopedics, Clinical Medical College of Yangzhou University, Yangzhou, China
| | - Bo Meng
- Department of Orthopedics, Graduate School of Dalian Medical University, Dalian, China
| | - Wenjie Zhao
- Department of Orthopedics, Graduate School of Dalian Medical University, Dalian, China
| | - Man Hu
- Department of Orthopedics, Graduate School of Dalian Medical University, Dalian, China
| | - Yongbo Zhang
- Department of Orthopedics, Graduate School of Dalian Medical University, Dalian, China
| | - Liuyang Chen
- Department of Orthopedics, Clinical Medical College of Yangzhou University, Yangzhou, China
| | - Hua Sun
- Department of Orthopedics, Clinical Medical College of Yangzhou University, Yangzhou, China
| | - Liang Zhang
- Department of Orthopedics, Clinical Medical College of Yangzhou University, Yangzhou, China
| | - Haisheng Wu
- Department of Orthopedics, Clinical Medical College of Yangzhou University, Yangzhou, China.
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Liu Y, Wu H, Bao S, Huang H, Tang Z, Dong H, Liu J, Chen S, Wang N, Wu Z, Zhang Z, Shi L, Li X, Guo Z. Clinical application of 3D-printed biodegradable lumbar interbody cage (polycaprolactone/β-tricalcium phosphate) for posterior lumbar interbody fusion. J Biomed Mater Res B Appl Biomater 2023; 111:1398-1406. [PMID: 36883804 DOI: 10.1002/jbm.b.35244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Revised: 02/16/2023] [Accepted: 02/23/2023] [Indexed: 03/09/2023]
Abstract
A novel 3D-printed biodegradable cage composed of polycaprolactone (PCL) and beta-tricalcium phosphate (β-TCP) in a mass ratio of 50:50, with stable resorption patterns and mechanical strength has been developed for lumbar interbody fusion. This is a prospective cohort study to evaluate the short- and mid-term safety and efficacy of this biodegradable cage in posterior lumbar interbody fusion (PLIF) surgery. This was a prospective single-arm pilot clinical trial in 22 patients with a follow-up time of 1, 3, 6, and 12 months, postoperatively. Clinical outcomes were assessed using the Japanese Orthopedic Association Back Pain Evaluation Questionnaire (JOABPEQ) and Visual analogue scale (VAS) for leg pain and low back pain. Radiological examination included X-ray, CT scan, and three-dimensional reconstruction to evaluate surgical indications, intervertebral space height (ISH), intervertebral bone fusion and cage degradation. A total of 22 patients was included, with an average age of 53.5 years. Among 22 patients, one patient lost to follow-up and one patient withdrew from the clinical trial because of cage retropulsion. The remaining 20 patients showed significant improvement in clinical and imaging outcomes compared to the preoperative period. The overall mean VAS for back decreased from 5.85 ± 0.99 preoperatively to 1.15 ± 0.86 at the 12-month follow-up (p < .001); the VAS for leg decreased from 5.75 ± 1.11 to 1.05 ± 0.76 (p < .001); the JOA score improved from 13.8 ± 2.64 to 26.45 ± 2.46 (p < .001). The mean intervertebral space height (ISH) increased from 11.01 ± 1.75 mm preoperatively to 12.67 ± 1.89 mm at the 12-month follow-up and the bone fusion reached 95.2% (20/21 disc segments). Partial resorption (inferior to 50% compared with the initial cage size) were found in all cages (21/21). The clinical and radiological assessments showed that the application of 3D-printed biodegradable PCL/β-TCP cages in PLIF yielded satisfactory results at the 12-month follow-up. In the future, long-term clinical observations and controlled clinical trials are required to further validate the safety and efficacy of this novel cage.
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Affiliation(s)
- Yichao Liu
- Department of Orthopaedics, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, People's Republic of China
| | - Hao Wu
- Department of Orthopaedics, Tangdu Hospital
- , Fourth Military Medical University, Xi'an, Shaanxi, People's Republic of China
| | - Shusen Bao
- Department of Orthopaedics, Tangdu Hospital
- , Fourth Military Medical University, Xi'an, Shaanxi, People's Republic of China
| | - Hai Huang
- Department of Orthopaedics, Tangdu Hospital
- , Fourth Military Medical University, Xi'an, Shaanxi, People's Republic of China
| | - Zhen Tang
- Department of Orthopaedics, Tangdu Hospital
- , Fourth Military Medical University, Xi'an, Shaanxi, People's Republic of China
| | - Hui Dong
- Department of Orthopaedics, Tangdu Hospital
- , Fourth Military Medical University, Xi'an, Shaanxi, People's Republic of China
| | - Jiaqi Liu
- Student Brigade of Basic Medicine School, Fourth Military Medical University, Xi'an, Shaanxi, People's Republic of China
| | - Shengxiu Chen
- Student Brigade of Basic Medicine School, Fourth Military Medical University, Xi'an, Shaanxi, People's Republic of China
| | - Ning Wang
- Department of Orthopaedics, Tangdu Hospital
- , Fourth Military Medical University, Xi'an, Shaanxi, People's Republic of China
| | - Zhigang Wu
- Department of Orthopaedics, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, People's Republic of China
| | - Zhiyong Zhang
- Center of Translational Research in Regenerative Medicine, Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, People's Republic of China
| | - Lei Shi
- Department of Orthopaedics, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, People's Republic of China
| | - Xiaokang Li
- Department of Orthopaedics, Tangdu Hospital
- , Fourth Military Medical University, Xi'an, Shaanxi, People's Republic of China
| | - Zheng Guo
- Department of Orthopaedics, Tangdu Hospital
- , Fourth Military Medical University, Xi'an, Shaanxi, People's Republic of China
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Li G, Yang L, Wu G, Qian Z, Li H. An update of interbody cages for spine fusion surgeries: from shape design to materials. Expert Rev Med Devices 2022; 19:977-989. [PMID: 36617696 DOI: 10.1080/17434440.2022.2165912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
INTRODUCTION Discectomy and interbody fusion are widely used in the treatment of intervertebral disc-related diseases. Among them, the interbody cage plays a significant role. However, the complications related to the interbody cage, such as nonunion or pseudoarthrosis, subsidence, loosening, and prolapse of the cage, cannot be ignored. By changing the design and material of the interbody fusion cage, a better fusion effect can be obtained, the incidence of appeal complications can be reduced, and the quality of life of patients after interbody fusion can be improved. AREAS COVERED This study reviewed the research progress of cage design and material and discussed the methods of cage design and material to promote intervertebral fusion. EXPERT OPINION Current treatment of cervical and lumbar degenerative disease requires interbody fusion to maintain decompression and to promote fusion and reduce the incidence of fusion failure through improvements in implant material, design, internal structure, and function. However, interbody fusion is not an optimal solution for treating vertebral instability.Abbreviations: ACDF, Anterior cervical discectomy and fusion; ALIF, anterior lumbar interbody fusion; Axi-aLIF, axial lumbar interbody fusion; BAK fusion cage, Bagby and Kuslich fusion cage; CADR, cervical artificial disc replacement; DBM, decalcified bone matrix; HA, hydroxyapatite; LLIF/XLIF, lateral or extreme lateral interbody fusion; MIS-TLIF, minimally invasive transforaminal lumbar interbody fusion; OLIF/ATP, oblique lumbar interbody fusion/anterior to psoas; PEEK, Poly-ether-ether-ketone; PLIF, posterior lumbar interbody fusion; ROI-C, Zero-profile Anchored Spacer; ROM, range of motion; SLM, selective melting forming; TLIF, transforaminal lumbar interbody fusion or.
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Affiliation(s)
- Guangshen Li
- Nantong University Medical School, 226000, Nantong, Jiangsu, China.,Department of Orthopedics, Hospital Affiliated 5 to Nantong University, Taizhou People's Hospital, 225300, Taizhou, China.,Department of Orthopedics, The Affiliated Taizhou People's Hospital of Nanjing Medical University, Taizhou, China
| | - Lei Yang
- Department of Orthopedics, The Affiliated Taizhou People's Hospital of Nanjing Medical University, Taizhou, China
| | - Gang Wu
- Department of Orthopedics, The Affiliated Taizhou People's Hospital of Nanjing Medical University, Taizhou, China
| | - Zhanyang Qian
- School of Medicine, Southeast University, Nanjing, China; Spine Center, Zhongda Hospital of Southeast University, Nanjing, China
| | - Haijun Li
- Nantong University Medical School, 226000, Nantong, Jiangsu, China.,Department of Orthopedics, Hospital Affiliated 5 to Nantong University, Taizhou People's Hospital, 225300, Taizhou, China.,Department of Orthopedics, The Affiliated Taizhou People's Hospital of Nanjing Medical University, Taizhou, China.,Taizhou School of Clinical Medicine, Nanjing Medical University, Taizhou, Jiangsu, China
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Alan N, Vodovotz L, Muthiah N, Deng H, Guha D, Agarwal N, Ozpinar A, Mushlin HM, Puccio L, Hamilton DK, Okonkwo DO, Kanter AS. Subsidence after lateral lumbar interbody fusion using a 3D-printed porous titanium interbody cage: single-institution case series. J Neurosurg Spine 2022; 37:663-669. [PMID: 35594892 DOI: 10.3171/2022.4.spine2245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 04/07/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Cage subsidence is a well-known phenomenon after lateral lumbar interbody fusion (LLIF), occurring in 10%-20% of cases. A 3D-printed porous titanium (pTi) cage has a stiffness that mimics the modulus of elasticity of native vertebrae, which reduces stress at the bone-hardware interface, lowering the risk of subsidence. In this study, the authors evaluated their institutional rate of subsidence and resultant reoperation in patients who underwent LLIF using a 3D-printed pTi interbody cage. METHODS This is a retrospective case series of consecutive adult patients who underwent LLIF using pTi cages from 2018 to 2020. Demographic and clinical characteristics including age, sex, bone mineral density, smoking status, diabetes, steroid use, number of fusion levels, posterior instrumentation, and graft size were collected. The Marchi subsidence grade was determined at the time of last follow-up. Outcome measures of interest were subsidence and resultant reoperation. Univariable logistic regression analysis was performed to assess the extent to which clinical and operative characteristics were associated with Marchi grade I-III subsidence. Significance was assessed at p < 0.05. RESULTS Fifty-five patients (38 with degenerative disc disease and 17 with adult spinal deformity) were treated with 97 pTi interbody cages with a mean follow-up of 18 months. The mean age was 63.6 ± 10.1 years, 60% of patients were female, and 36% of patients had osteopenia or osteoporosis. Patients most commonly underwent single-level LLIF (58.2%). Sixteen patients (29.1%) had posterior instrumentation. The subsidence grade distribution was as follows: 89 (92%) grade 0, 5 (5%) grade I, 2 (2%) grade II, and 1 (1%) grade III. No patients who were active or prior smokers and no patients with posterior instrumentation experienced graft subsidence. No clinical or operative characteristics were significantly associated with graft subsidence. One patient (1.8%) required reoperation because of subsidence. CONCLUSIONS In this institutional case series, subsidence of pTi intervertebral cages after LLIF occurred in 8% of operated levels, 3% of which were grade II or III. Only 1 patient required reoperation. These reported rates are lower than those reported for polyetheretherketone implants. Further studies are necessary to compare the impact of these cage materials on subsidence after LLIF.
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Affiliation(s)
- Nima Alan
- 1Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh
| | - Lena Vodovotz
- 2University of Pittsburgh Medical Center, School of Medicine, Pittsburgh, Pennsylvania
| | - Nallammai Muthiah
- 2University of Pittsburgh Medical Center, School of Medicine, Pittsburgh, Pennsylvania
| | - Hansen Deng
- 2University of Pittsburgh Medical Center, School of Medicine, Pittsburgh, Pennsylvania
| | - Daipayan Guha
- 3Department of Surgery, Division of Neurosurgery, University of Toronto, Ontario, Canada
| | - Nitin Agarwal
- 4Department of Neurological Surgery, University of California, San Francisco, California
| | - Alp Ozpinar
- 1Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh
| | - Harry M Mushlin
- 5Department of Neurological Surgery, Stony Brook University, Stony Brook, New York
| | - Lauren Puccio
- 2University of Pittsburgh Medical Center, School of Medicine, Pittsburgh, Pennsylvania
| | - David K Hamilton
- 1Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh
| | - David O Okonkwo
- 1Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh
| | - Adam S Kanter
- 1Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh
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What can we learn from long-term studies on chronic low back pain? A scoping review. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2022; 31:901-916. [PMID: 35044534 DOI: 10.1007/s00586-022-07111-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 12/22/2021] [Accepted: 01/05/2022] [Indexed: 10/19/2022]
Abstract
PURPOSE A scoping review was conducted with the objective to identify and map the available evidence from long-term studies on chronic non-specific low back pain (LBP), to examine how these studies are conducted, and to address potential knowledge gaps. METHOD We searched MEDLINE and EMBASE up to march 2021, not restricted by date or language. Experimental and observational study types were included. Inclusion criteria were: participants between 18 and 65 years old with non-specific sub-acute or chronic LBP, minimum average follow-up of > 2 years, and studies had to report at least one of the following outcome measures: disability, quality of life, work participation, or health care utilization. Methodological quality was assessed using the Effective Public Health Practice Project quality assessment. Data were extracted, tabulated, and reported thematically. RESULTS Ninety studies met the inclusion criteria. Studies examined invasive treatments (72%), conservative (21%), or a comparison of both (7%). No natural cohorts were included. Methodological quality was weak (16% of studies), moderate (63%), or strong (21%) and generally improved after 2010. Disability (92%) and pain (86%) outcomes were most commonly reported, followed by work (25%), quality of life (15%), and health care utilization (4%). Most studies reported significant improvement at long-term follow-up (median 51 months, range 26 months-18 years). Only 10 (11%) studies took more than one measurement > 2 year after baseline. CONCLUSION Patients with persistent non-specific LBP seem to experience improvement in pain, disability and quality of life years after seeking treatment. However, it remains unclear what factors might have influenced these improvements, and whether they are treatment-related. Studies varied greatly in design, patient population, and methods of data collection. There is still little insight into the long-term natural course of LBP. Additionally, few studies perform repeated measurements during long-term follow-up or report on patient-centered outcomes other than pain or disability.
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Basil GW, Sprau AC, Eliahu K, Borowsky PA, Wang MY, Yoon JW. Using Smartphone-Based Accelerometer Data to Objectively Assess Outcomes in Spine Surgery. Neurosurgery 2021; 88:763-772. [PMID: 33437988 DOI: 10.1093/neuros/nyaa505] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 09/21/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND In order to deliver optimal patient care, spine surgeons must integrate technological changes to arrive at novel measures of functional outcomes. Historically, subjective patient-reported outcome (PRO) surveys have been used to determine the relative benefit of surgical treatments. Using smartphone-based accelerometers, surgeons now have the ability to arrive at objective outcome metrics. OBJECTIVE To use Apple Health (Apple Inc, Cupertino, California) data to approximate physical activity levels before and after spinal fusion as an objective outcome measurement. METHODS Personal activity data were acquired retrospectively from the cellphones of consenting patients. These data were used to measure changes in activity level (daily steps, flights climbed, and distance traveled) before and after patients underwent spine surgery at a single institution by a single surgeon. After data collection, we investigated the demographic information and daily physical activity pre- and postoperatively of participating patients. RESULTS Twenty-three patients were included in the study. On average, patients first exceeded their daily 1-yr average distance walked, flights climbed, and steps taken at 10.3 ± 14, 7.6 ± 21.1, and 8 ± 9.9 wk, respectively. Mean flights climbed, distance traveled, and steps taken decreased significantly from 6 mo prior to surgery to 2 wk postoperatively. Distance traveled and steps taken significantly increased from 6 mo prior to surgery to 7 to 12 mo postoperatively. CONCLUSION We demonstrated a valuable supplement to traditional PROs by using smartphone-based activity data. This methodology yields a rich data set that has the potential to augment our understanding of patient recovery.
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Affiliation(s)
- Gregory W Basil
- Department of Neurological Surgery, University of Miami, Miami, Florida
| | - Annelise C Sprau
- Department of Neurological Surgery, University of Miami, Miami, Florida
| | - Karen Eliahu
- Department of Neurological Surgery, University of Miami, Miami, Florida
| | - Peter A Borowsky
- Department of Neurological Surgery, University of Miami, Miami, Florida
| | - Michael Y Wang
- Department of Neurological Surgery, University of Miami, Miami, Florida
| | - Jang W Yoon
- Department of Neurological Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
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Sasaki M, Umegaki M, Fukunaga T, Hijikata Y, Banba Y, Matsumoto K, Miyao Y. Vertebral Endplate Cyst Formation in Relation to Properties of Interbody Cages. Neurospine 2021; 18:170-176. [PMID: 33819943 PMCID: PMC8021841 DOI: 10.14245/ns.2040498.249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 09/13/2020] [Indexed: 11/19/2022] Open
Abstract
Objective This retrospective study aimed to compare vertebral endplate cyst formation (VECF), an early predictor for pseudoarthrosis, in different types of interbody cages.
Methods We reviewed 84 cases treated with single-level posterior/transforaminal lumbar interbody fusion. We utilized a polyetheretherketone cage in 20 cases (group P), a titanium cage in 16 cases (group Ti), a titanium-coating polyetheretherketone cage in 13 cases (group TiP) and a porous tantalum cage in 35 cases (group Tn). VECF was evaluated comparing the computed tomography scans taken at day 0 and 6-month postoperation. We defined VECF (+) as enlargement of a pre-existing cyst or de novo formation of a cyst with the diameter over 2 mm. We calculated the adjusted odds ratio (OR) and 95% confidence intervals (CIs) as an indicator of association between different types of cages and VECF using a logistic regression model.
Results VECF was observed in 13 (65%), 7 (44%), 9 (69%), and 8 (23%) cases in groups P, Ti, TiP and Tn, respectively. VECF correlated with the type of cage (p = 0.04). In comparison with group P, the proportion of VECF (+) cases was lower in group Tn (OR, 0.16; 95% CI, 0.04–0.60) but not different in group Ti (OR, 0.47; 95% CI, 0.10–2.20) and group TiP (OR, 1.06; 95% CI, 0.21–5.28). No patient underwent additional surgery for the fused spinal level during the follow-up periods (average, 37.9 months; range, 6–76 months).
Conclusion VECF was the least in the porous Tn cage, suggesting its potential superiority for initial stability.
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Affiliation(s)
- Manabu Sasaki
- Department of Neurosurgery and Spine Surgery, Iseikai Hospital, Osaka, Japan
| | - Masao Umegaki
- Department of Neurosurgery and Spine Surgery, Iseikai Hospital, Osaka, Japan
| | - Takanori Fukunaga
- Department of Neurosurgery and Spine Surgery, Iseikai Hospital, Osaka, Japan
| | - Yasukazu Hijikata
- Department of Spine and Lumbago Center, Kitasuma Hospital, Hyogo, Japan
| | - Yohei Banba
- Department of Neurosurgery and Spine Surgery, Iseikai Hospital, Osaka, Japan
| | - Katsumi Matsumoto
- Department of Neurosurgery and Spine Surgery, Iseikai Hospital, Osaka, Japan
| | - Yasuyoshi Miyao
- Department of Neurosurgery, Suita Municipal Hospital, Suita, Japan
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Walter C, Baumgärtner T, Trappe D, Frantz S, Exner L, Mederake M. Influence of Cage Design on Radiological and Clinical Outcomes in Dorsal Lumbar Spinal Fusions: A Comparison of Lordotic and Non-Lordotic Cages. Orthop Surg 2021; 13:863-875. [PMID: 33763988 PMCID: PMC8126915 DOI: 10.1111/os.12872] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 10/14/2020] [Accepted: 10/25/2020] [Indexed: 11/28/2022] Open
Abstract
Objectives To evaluate the comparison between lordotic and non‐lordotic transforaminal lumbar interbody fusion (TLIF) cages in degenerative lumbar spine surgery and analyze radiological as well as clinical outcome parameters in long‐term follow up. Methods In a retrospective study design, we compared 37 patients with non‐lordotic cage (NL‐group) and 40 with a 5° lordotic cage (L‐group) implanted mono‐ or bi‐segmental in TLIF‐technique from 2013 to 2016 and analyzed radiological parameters of pre‐ and postoperative (Lumbar lordosis (LL), segmental lordosis (SL), and pelvic tilt (PT), as well as clinical parameters in a follow‐up physical examination using the Oswestry disability index (ODI), Roland–Morris Score (RMS), and visual analog scale (VAS). Results Surgery was mainly performed in lower lumbar spine with a peak in L4/5 (mono‐segmental) and L4 to S1 (bi‐segmental), long‐term follow‐up was on average 4 years postoperative. According to the literature, we found significantly better results in radiological outcome in the L‐group compared to the NL‐group: LL increased 6° in L‐group (51° preoperative to 57° postoperative) and decreased 1° in NL‐group (50° to 49° (P < 0.001). Regarding SL, we found an increase of 5° in L‐group (13° to 18°) and no difference in NL‐group (15°)(P < 0.001). In PT, we found a clear benefit with a decrease of 2° in L‐group (21° to 19°) and no difference in NL‐group (P = 0.008). In direct group comparison, ODI in NL‐group was 23% vs 28% in L‐group (P = 0.25), RMS in NL‐group was 8 points vs 9 points in L‐group (P = 0.48), and VAS was in NL‐group 2.7 vs 3.2 in L‐group (P = 0.27) without significant differences. However, the clinical outcome in multivariate analysis indicated a significant multivariate influence across ODI and RMS of BMI (Wilks λ = 0.57, F [4, 44] = 3.61, P = 0.012) and preoperative SS (Wilks λ = 0.66, F [4, 44] = 2.54, P = 0.048). Age, gender, cage type and postoperative PT had no significant influence (P > 0.05). Intraoperatively, we saw three dura injuries that could be sutured without problems and had no consequences for the patient. In the follow‐up, we did not find any material‐related problems, such as broken screws or cage loosening, also no pseudarthrosis. Conclusion In conclusion, we think it's not cage design but other influenceable factors such as correct indication and adequate decompression that lead to surgical success and the minimal difference in the LL therefore seemed to be of subordinate importance.
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Ragni E, Perucca Orfei C, Bidossi A, De Vecchi E, Francaviglia N, Romano A, Maestretti G, Tartara F, de Girolamo L. Superior Osteo-Inductive and Osteo-Conductive Properties of Trabecular Titanium vs. PEEK Scaffolds on Human Mesenchymal Stem Cells: A Proof of Concept for the Use of Fusion Cages. Int J Mol Sci 2021; 22:ijms22052379. [PMID: 33673509 PMCID: PMC7956826 DOI: 10.3390/ijms22052379] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 02/19/2021] [Accepted: 02/23/2021] [Indexed: 12/20/2022] Open
Abstract
Fusion cages composed of titanium and its alloys are emerging as valuable alternative to standard polyetheretherketone (PEEK) ones routinely used in cervical and lumbar spine surgery. Aim of this study was to evaluate osteo-inductive and osteo-conductive ability of an innovative trabecular titanium (T-Ti) scaffold on human mesenchymal stem cells (hMSCs), in both absence and presence of biochemical osteogenic stimuli. Same abilities were assessed on PEEK and standard 2D plastic surface, the latter meant as gold-standard for in vitro differentiation studies. hMSCs adhered and colonized both T-Ti and PEEK scaffolds. In absence of osteogenic factors, T-Ti triggered osteogenic induction of MSCs, as demonstrated by alkaline phosphatase activity and calcium deposition increments, while PEEK and standard 2D did not. Addition of osteogenic stimuli reinforced osteogenic differentiation of hMSCs cultured on T-Ti in a significantly higher manner with respect to standard 2D plastic culture surfaces, whereas PEEK almost completely abolished the process. T-Ti driven differentiation towards osteoblasts was confirmed by gene and marker expression analyses, even in absence of osteogenic stimuli. These results clearly indicate superior in vitro osteo-inductive and osteo-conductive capacity of T-Ti compared to PEEK, and make ground for further studies supporting the use of T-Ti cages to improve bone fusion.
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Affiliation(s)
- Enrico Ragni
- Laboratorio di Biotecnologie Applicate all’Ortopedia, IRCCS Istituto Ortopedico Galeazzi, Via R. Galeazzi 4, I-20161 Milano, Italy; (E.R.); (C.P.O.)
| | - Carlotta Perucca Orfei
- Laboratorio di Biotecnologie Applicate all’Ortopedia, IRCCS Istituto Ortopedico Galeazzi, Via R. Galeazzi 4, I-20161 Milano, Italy; (E.R.); (C.P.O.)
| | - Alessandro Bidossi
- Laboratory of Clinical Chemistry and Microbiology, IRCCS Istituto Ortopedico Galeazzi, Via R. Galeazzi 4, I-20161 Milano, Italy; (A.B.); (E.D.V.)
| | - Elena De Vecchi
- Laboratory of Clinical Chemistry and Microbiology, IRCCS Istituto Ortopedico Galeazzi, Via R. Galeazzi 4, I-20161 Milano, Italy; (A.B.); (E.D.V.)
| | - Natale Francaviglia
- Neurochirurgia Funzionale, Istituto Ortopedico Villa Salus, Contrada Spalla, I-96010 Melilli, Italy;
| | - Alberto Romano
- Unità Operativa di Neurochirurgia, Humanitas Istituto Clinico Catanese, Contrada Cubba Marletta 11, I-95045 Misterbianco, Italy;
| | | | | | - Laura de Girolamo
- Laboratorio di Biotecnologie Applicate all’Ortopedia, IRCCS Istituto Ortopedico Galeazzi, Via R. Galeazzi 4, I-20161 Milano, Italy; (E.R.); (C.P.O.)
- Correspondence: ; Tel.: +39-02-66214059
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Song C, Chang H, Zhang D, Zhang Y, Shi M, Meng X. Biomechanical Evaluation of Oblique Lumbar Interbody Fusion with Various Fixation Options: A Finite Element Analysis. Orthop Surg 2021; 13:517-529. [PMID: 33619850 PMCID: PMC7957407 DOI: 10.1111/os.12877] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 09/23/2020] [Accepted: 10/26/2020] [Indexed: 01/25/2023] Open
Abstract
Objective The aim of the present study was to clarify the biomechanical properties of oblique lumbar interbody fusion (OLIF) using different fixation methods in normal and osteoporosis spines. Methods Normal and osteoporosis intact finite element models of L1–S1 were established based on CT images of a healthy male volunteer. Group A was the normal models and group B was the osteoporosis model. Each group included four subgroups: (i) intact; (ii) stand‐alone cage (Cage); (iii) cage with lateral plate and two lateral screws (LP); and (iv) cage with bilateral pedicle screws and rods (BPSR). The L3–L4 level was defined as the surgical segment. After validating the normal intact model, compressive load of 400 N and torsional moment of 10 Nm were applied to the superior surface of L2 to simulate flexion, extension, left bending, right bending, left rotation, and right rotation motions. Surgical segmental range of motion (ROM), cage stress, endplate stress, supplemental fixation stress, and stress distribution were analyzed in each group. Results Cage provided the minimal reduction of ROM among all motions (normal, 82.30%–98.81%; osteoporosis, 92.04%–97.29% of intact model). BPSR demonstrated the maximum reduction of ROM (normal, 43.94%–61.13%; osteoporosis, 45.61%–62.27% of intact model). The ROM of LP was between that of Cage and BPSR (normal, 63.25%–79.72%; osteoporosis, 70%–87.15% of intact model). Cage had the minimal cage stress and endplate stress. With the help of LP and BPSR fixation, cage stress and endplate stress were significantly reduced in all motions, both in normal and osteoporosis finite element models. However, BPSR had more advantages. For cage stress, BPSR was at least 75.73% less than that of Cage in the normal model, and it was at least 80.10% less than that of Cage in the osteoporosis model. For endplate stress, BPSR was at least 75.98% less than that of Cage in the normal model, and it was at least 78.06% less than that of Cage in the osteoporosis model. For supplemental fixation stress, BPSR and LP were much less than the yield strength in all motions in the two groups. In addition, the comparison between the two groups showed that the ROM, cage stress, endplate stress, and supplemental fixation stress in the normal model were less than in the osteoporosis model when using the same fixation option of OLIF. Conclusion Oblique lumbar interbody fusion with BPSR provided the best biomechanical stability both in normal and osteoporosis spines. The biomechanical properties of the normal spine were better than those of the osteoporosis spine when using the same fixation option of OLIF.
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Affiliation(s)
- Chengjie Song
- Department of Spinal Surgery, The Third Hospital of Hebei Medical University, ShiJiazhuang, China
| | - Hengrui Chang
- Department of Spinal Surgery, The Third Hospital of Hebei Medical University, ShiJiazhuang, China
| | - Di Zhang
- Department of Spinal Surgery, The Third Hospital of Hebei Medical University, ShiJiazhuang, China
| | - Yingze Zhang
- Department of Spinal Surgery, The Third Hospital of Hebei Medical University, ShiJiazhuang, China
| | - Mingxin Shi
- Department of Spinal Surgery, The Third Hospital of Hebei Medical University, ShiJiazhuang, China
| | - Xianzhong Meng
- Department of Spinal Surgery, The Third Hospital of Hebei Medical University, ShiJiazhuang, China
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Yanai Y, Matsukawa K, Kato T, Yato Y. Factors important in bone union after posterior lumbar interbody fusion using the cortical bone trajectory technique. JOURNAL OF SPINE SURGERY 2020; 6:713-720. [PMID: 33447673 DOI: 10.21037/jss-20-608] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Background The cortical bone trajectory (CBT) technique has developed as an alternative to the traditional pedicle screw fixation technique due to its minimum invasiveness for screw insertion and rigid fixation for posterior lumbar interbody fusion (PLIF). However, the factors contributing to bone union after CBT-PLIF is a controversial subject. The aim of this study was to investigate factors important to bone union after CBT-PLIF. Methods We analyzed 69 consecutive patients who underwent single-level CBT-PLIF from October 2011 to December 2016 and were followed for over two years. Bone union was evaluated using computed tomography (CT) and dynamic assessment in the radiograph within two years after CBT-PLIF. The following factors that may influence bone union were investigated: age, gender, bone mineral density (BMD), cage materials [polyether-ether-ketone (PEEK) or titanium (Ti)], vertebral-slip (neutral), translational motion (flexion/extension), angular motion (flexion/extension), screw depth into the vertebral body (% depth), interval of bilateral screw heads, and cage position. Results The bone union rate at the two-year follow-up was 88.4% (61/69). A univariate analysis revealed that variables with values of P<0.20 were age (P<0.01), gender (P=0.07), cage material (P=0.18), vertebral slip (neutral) (P=0.14), % depth (P=0.086), and cage position (P<0.01). Multiple logistic regression analyses revealed that factors related to bone union were young age (P<0.01), Ti cage (P<0.01), small vertebral slip (neutral) (P<0.01), high % depth (P<0.01), and anterior cage position (P<0.01). Conclusions For CBT-PLIF, deeper screw insertion into the vertebral body, anterior cage placement, and Ti cage usage may be important surgical techniques to achieve a successful bone union.
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Affiliation(s)
- Yoshihide Yanai
- Department of Orthopaedic Surgery, National Hospital Organization, Murayama Medical Center, Musashimurayama, Tokyo, Japan
| | - Keitaro Matsukawa
- Department of Orthopaedic Surgery, National Hospital Organization, Murayama Medical Center, Musashimurayama, Tokyo, Japan
| | - Takashi Kato
- Department of Orthopaedic Surgery, National Hospital Organization, Murayama Medical Center, Musashimurayama, Tokyo, Japan
| | - Yoshiyuki Yato
- Department of Orthopaedic Surgery, National Hospital Organization, Murayama Medical Center, Musashimurayama, Tokyo, Japan
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Verma R, Virk S, Qureshi S. Interbody Fusions in the Lumbar Spine: A Review. HSS J 2020; 16:162-167. [PMID: 32523484 PMCID: PMC7253570 DOI: 10.1007/s11420-019-09737-4] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 10/17/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Lumbar interbody fusion is among the most common types of spinal surgery performed. Over time, the term has evolved to encompass a number of different approaches to the intervertebral space, as well as differing implant materials. Questions remain over which approaches and materials are best for achieving fusion and restoring disc height. QUESTIONS/PURPOSES We reviewed the literature on the advantages and disadvantages of various methods and devices used to achieve and augment fusion between the disc spaces in the lumbar spine. METHODS Using search terms specific to lumbar interbody fusion, we searched PubMed and Google Scholar and identified 4993 articles. We excluded those that did not report clinical outcomes, involved cervical interbody devices, were animal studies, or were not in English. After exclusions, 68 articles were included for review. RESULTS Posterior approaches have advantages, such as providing 360° support through a single incision, but can result in retraction injury and do not always restore lordosis or correct deformity. Anterior approaches allow for the largest implants and good correction of deformities but can result in vascular, urinary, psoas muscle, or lumbar plexus injury and may require a second posterior procedure to supplement fixation. Titanium cages produce improved osteointegration and fusion rates but also increase subsidence caused by the stiffness of titanium relative to bone. Polyetheretherketone (PEEK) has an elasticity closer to that of bone and shows less subsidence than titanium cages, but as an inert compound PEEK results in lower fusion rates and greater osteolysis. Combination PEEK-titanium coating has not yet achieved better results. Expandable cages were developed to increase disc height and restore lumbar lordosis, but the data on their effectiveness have been inconclusive. Three-dimensionally (3D)-printed cages have shown promise in biomechanical and animal studies at increasing fusion rates and reducing subsidence, but additive manufacturing options are still in their infancy and require more investigation. CONCLUSIONS All of the approaches to spinal fusion have plusses and minuses that must be considered when determining which to use, and newer-technology implants, such as PEEK with titanium coating, expandable, and 3D-printed cages, have tried to improve upon the limitations of existing grafts but require further study.
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Affiliation(s)
- Ravi Verma
- Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 E. 70th St., New York, NY 10021 USA
| | - Sohrab Virk
- Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 E. 70th St., New York, NY 10021 USA
| | - Sheeraz Qureshi
- Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 E. 70th St., New York, NY 10021 USA
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Lee KY, Lee JH, Kang KC, Shin SJ, Shin WJ, Im SK, Park JH. Strategy for obtaining solid fusion at L5-S1 in adult spinal deformity: risk factor analysis for nonunion at L5-S1. J Neurosurg Spine 2020; 33:323-331. [PMID: 32302980 DOI: 10.3171/2020.2.spine191181] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 02/10/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Maintaining lumbosacral (LS) arthrodesis and global sagittal balance after long fusion to the sacrum remains an important issue in the surgical treatment for adult spinal deformity (ASD). The importance and usefulness of LS fixation have been documented, but the optimal surgical long fusion to the sacrum remains a matter for debate. Therefore, the authors performed a retrospective study to evaluate fusion on CT scans and the risk factors for LS pseudarthrosis (nonunion) after long fusion to the sacrum in ASD. METHODS The authors performed a retrospective study of 59 patients with lumbar degenerative kyphosis (mean age 69.6 years) who underwent surgical correction, including an interbody fusion of the L5-S1, with a minimum 2-year follow-up. Achievement of LS fusion was evaluated by analyzing 3D-CT scans at 3 months, 6 months, 9 months, 1 year, and 2 years after surgery. Patients were classified into a union group (n = 36) and nonunion group (n = 23). Risk factors for nonunion were analyzed, including patient and surgical factors. RESULTS The overall fusion rate was 61% (36/59). Regarding radiological factors, optimal sagittal balance at the final follow-up significantly differed between two groups. There were no significant differences in terms of patient factors, and no significant differences with respect to the use of pedicle subtraction osteotomy, the number of fused segments, the proportion of anterior versus posterior interbody fusion, S2 alar iliac fixation versus conventional iliac fixation, or loosening of sacral or iliac screws. However, the proportion of metal cages to polyetheretherketone cages and the proportion of sacropelvic fixation were significantly higher in the union group (p = 0.022 and p < 0.05, respectively). CONCLUSIONS LS junction fusion is crucial for global sagittal balance, and the use of iliac screws in addition to LS interbody fusion using a metal cage improves the outcomes of long fusion surgery for ASD patients.
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Is Multilevel Anterior Lumbar Interbody Fusion (ALIF) Superior to Pedicle Subtraction Osteotomy (PSO) for Degenerative Lumbar Deformity? Clin Spine Surg 2020; 33:1-4. [PMID: 30932932 DOI: 10.1097/bsd.0000000000000817] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Sun D, Zhang ZH, Mei G, Hou TY, Li Y, Xu JZ, Luo F. Comparison of Anterior only and Combined Anterior and Posterior Approach in Treating Lumbosacral Tuberculosis. Sci Rep 2019; 9:18475. [PMID: 31811159 PMCID: PMC6898139 DOI: 10.1038/s41598-019-53800-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 11/04/2019] [Indexed: 02/06/2023] Open
Abstract
A combined anterior and posterior (AP) surgical approach is a popular treatment modality of lumbosacral tuberculosis, but it is often traumatic and complicated. The present study aims to find whether the anterior only approach with the ARCH plate system is less invasive than the AP approach in treating lumbosacral tuberculosis. The ARCH plate system is an innovative anatomic lumbosacral anterior multi-directional locking plate system which was devised with due consideration to the anatomic features of the lumbosacral spine and irregular destruction of involved vertebral endplates. In this retrospective study, 32 patients with lumbosacral tuberculosis underwent surgeries via either the anterior only approach (ARCH group, 18 patients) using the ARCH system or the conventional combined anterior and posterior approach (AP group, 14 patients). American Spinal Injury Association (ASIA) scores, Visual Analogue Scale (VAS) scores, Oswestry Disability Index (ODI), bone union status, ESR, CRP, intervertebral foraminal height between L5 and S1, the vertical height between the anterior upper edge of L5 and S1 vertebral body, lumbosacral angle, and the physiological lordosis of between L1 and S1 from both groups were recorded and compared. All patients were followed up for at least two years. The average duration of operation, blood loss, and length of hospital admission of the ARCH group (154.6 min, 361.1 ml&18.3days) was significantly smaller and shorter(p < 0.001, p < 0.001 & p = 0.008) that those of the AP group(465.5 min, 814.3 ml & 24.6days). The ODI score(p = 0.08, 0.471, 0.06, 0.07, 0.107), the VAS score(p = 0.099, 0.249, 0.073, 0.103, 0.273), the intervertebral foraminal height between L5 and S1(p = 0.826, 0.073, 0.085), L5-S1 height(p = 0.057, 0.234, 0.094), lumbosacral angle(p = 0.052, 0.242, 0.825), and L5-S1 lordosis(p = 0.146, 0.129, 0.053) of both groups showed no significant difference in any of the time points. The anterior only approach using the ARCH system is as effective as the combined anterior and posterior approach and is less traumatic in treating lumbosacral tuberculosis.
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Affiliation(s)
- Dong Sun
- Department of Orthopedics, Southwest Hospital, National & Regional United Engineering Laboratory of Tissue Engineering, The Third Military Medical University (Army Medical University) of PLA, Chongqing, 400038, China
| | - Ze-Hua Zhang
- Department of Orthopedics, Southwest Hospital, National & Regional United Engineering Laboratory of Tissue Engineering, The Third Military Medical University (Army Medical University) of PLA, Chongqing, 400038, China
| | - Gang Mei
- Department of Orthopedics, Southwest Hospital, National & Regional United Engineering Laboratory of Tissue Engineering, The Third Military Medical University (Army Medical University) of PLA, Chongqing, 400038, China
| | - Tian-Yong Hou
- Department of Orthopedics, Southwest Hospital, National & Regional United Engineering Laboratory of Tissue Engineering, The Third Military Medical University (Army Medical University) of PLA, Chongqing, 400038, China
| | - Yang Li
- Department of Orthopedics, Southwest Hospital, National & Regional United Engineering Laboratory of Tissue Engineering, The Third Military Medical University (Army Medical University) of PLA, Chongqing, 400038, China
| | - Jian-Zhong Xu
- Department of Orthopedics, Southwest Hospital, National & Regional United Engineering Laboratory of Tissue Engineering, The Third Military Medical University (Army Medical University) of PLA, Chongqing, 400038, China
| | - Fei Luo
- Department of Orthopedics, Southwest Hospital, National & Regional United Engineering Laboratory of Tissue Engineering, The Third Military Medical University (Army Medical University) of PLA, Chongqing, 400038, China.
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Elfiky TA, Patil ND, Allam Y, Ragab R. Endplate Changes with Polyetheretherketone Cages in Posterior Lumbar Interbody Fusion. Asian Spine J 2019; 14:229-237. [PMID: 31711063 PMCID: PMC7113474 DOI: 10.31616/asj.2019.0124] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Accepted: 06/12/2019] [Indexed: 11/23/2022] Open
Abstract
Study Design A retrospective radiographic analysis. Purpose The aim of the current study is to assess endplate changes after the use of polyetheretherketone (PEEK) cages in posterior lumbar interbody fusion (PLIF). Overview of Literature A few recent reports had revealed endplate abnormalities due to PEEK cages, which may lead to nonunions. Methods A retrospective computed tomography (CT)-based analysis of the endplate cavities and fusion status following PLIFs with PEEK cages was conducted by two independent observers. The term “cavity” was used to describe the endplate changes. The vertebral endplate cavities were assessed according to the size, multiplicity, location, and presence or absence of sclerosis. Results There were 86 fixed levels in 65 consecutive patients, with a mean age of 35.44±19.60 years. The mean follow-up was 16.5±10.1 months (range, 6–57 months). Definite fusion was seen in 56 levels (65.12%) by observer 1 versus 44 levels (51.16) by observer 2. The strength of agreement was moderate. Endplate cavities were observed in 42 levels (48.84%) by observer 1 versus 47 levels (54.65%) by observer 2, with fair agreement. The strengths of agreement for the locations, multiplicity, and size were moderate, fair, and poor, respectively. Neither age, sex, etiology, levels, nor follow-up period was significantly associated with the presence of cavities. With regard to fusions, the nonunions detected by observer 1 were significantly associated with the presence of cavities (p<0.0001). However, those detected by observer 2 were nearly significant (p=0.05). Conclusions There was a high rate of unfavorable radiographic findings in the form of endplate cavities in PLIF cases with PEEK cages. A more comprehensive classification for the assessment of fusions and endplate cavities should be formulated. We strongly recommend further CT-based studies with larger sample size and longer follow-up periods.
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Affiliation(s)
| | | | - Yasser Allam
- Spine Unit, Al-Hadra University Hospital, Alexandria, Egypt
| | - Raafat Ragab
- Spine Unit, Al-Hadra University Hospital, Alexandria, Egypt
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Gunzburg R, Colloca CJ, Jones CF, Hall DJ, McAviney J, Callary S, Hegazy MA, Szpalski M, Freeman BJC. Does nanoscale porous titanium coating increase lumbar spinal stiffness of an interbody fusion cage? An in vivo biomechanical analysis in an ovine model. Clin Biomech (Bristol, Avon) 2019; 67:187-196. [PMID: 31176064 DOI: 10.1016/j.clinbiomech.2019.04.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 04/29/2019] [Accepted: 04/30/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Quantitative objective measures to determine fusion achievement further enable the comparison of new technologies, such as interbody cage surface enhancement. Our aims were to compare in vivo biomechanical responses of ovine L4/5 lumbar motion segments with two cages: 1) Polyetheretherketone or 2) Polyetheretherketone with a nanosurfaced titanium porous scaffold from Nanovis, Inc. METHODS Fourteen Merino sheep randomly received either 1) standard Polyetheretherketone cage or 2) Nanocoated Polyetheretherketone cage at L4/L5 with autologous bone graft. At baseline and one-year follow-up, dynamic spinal stiffness was quantified in vivo using a validated mechanical assessment at 2 Hz, 6 Hz, and 12 Hz. The dorsoventral secant stiffness (ky = force/displacement, N/mm) and L4-L5 accelerations were determined at each frequency. A repeated measures analysis of variance with Bonferonni correction was used to evaluate within and between group differences among the biomechanical variables. FINDINGS Both implants increased spinal stiffness at 2 Hz (21 and 39%, respectively, p < .005), and at 6 Hz (12 and 27%, p < .0001). Significantly greater spinal stiffness was observed with Nanocoated Polyetheretherketone at one-year for both frequencies (p < .05). No significant differences were observed at 12 Hz within or between groups. L4-L5 dorsoventral accelerations were significantly decreased one year following cage placement only with Nanocoated Polyetheretherketone (p < .05) and greater reductions in acceleration were observed with Nanocoated Polyetheretherketone compared to standard Polyetheretherketone (p < .05). INTERPRETATION Both cages increased spinal stiffness, yet, nanosurfaced cages resulted in greater spinal stiffness changes and decreases in L4-L5 accelerations. These findings may assist in clinical decision making and post-operative recovery strategies.
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Affiliation(s)
- Robert Gunzburg
- Department of Orthopaedic Surgery, Edith Cavell Clinic, Brussels, Belgium.
| | | | - Claire F Jones
- Adelaide Centre for Spinal Research, SA Pathology, Adelaide, Australia; Centre for Orthopaedic and Trauma Research, University of Adelaide, Australia
| | - David J Hall
- Adelaide Centre for Spinal Research, SA Pathology, Adelaide, Australia; Department of Spinal Surgery, Royal Adelaide Hospital, Adelaide, Australia
| | | | - Stuart Callary
- School of Mechanical Engineering, University of Adelaide, Australia
| | - Mostafa A Hegazy
- Science Department, Southwest Minnesota State University, Marshall, MN, USA
| | - Marek Szpalski
- Department of Orthopedics, Hôpitaux Iris Sud/IRIS South Teaching Hospitals, Brussels, Belgium
| | - Brian J C Freeman
- Adelaide Centre for Spinal Research, SA Pathology, Adelaide, Australia; Centre for Orthopaedic and Trauma Research, University of Adelaide, Australia; Department of Spinal Surgery, Royal Adelaide Hospital, Adelaide, Australia
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Patel DV, Yoo JS, Karmarkar SS, Lamoutte EH, Singh K. Interbody options in lumbar fusion. JOURNAL OF SPINE SURGERY 2019; 5:S19-S24. [PMID: 31380489 DOI: 10.21037/jss.2019.04.04] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Interbody devices have revolutionized lumbar fusion surgery by enhancing mechanical stability, optimizing sagittal parameters, and maximizing fusion potential. There are several lumbar interbody fusion approaches available for varying pathologic etiologies, surgical index levels, or due to surgeon preference. With the advancement of spinal instrumentation and interbody devices, a variety of cage materials and dimensions have been engineered to accommodate various lumbar fusion approaches. The efficacy of a fusion is dependent on the shape, size, and material makeup of that interbody device. Since there are numerous cages available in today's market, it is important to find the optimal cage to best accommodate specific lumbar fusion cases. This review will explain the properties and future advancements of various interbody devices available for lumbar fusions.
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Affiliation(s)
- Dil V Patel
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Joon S Yoo
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Sailee S Karmarkar
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Eric H Lamoutte
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Kern Singh
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
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22
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Manabe H, Sakai T, Morimoto M, Tezuka F, Yamashita K, Takata Y, Sairyo K. Radiological Outcomes of Posterior Lumbar Interbody Fusion Using a Titanium-coated PEEK Cage. THE JOURNAL OF MEDICAL INVESTIGATION 2019; 66:119-122. [PMID: 31064922 DOI: 10.2152/jmi.66.119] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
INTRODUCTION Titanium (Ti) coated polyether ether ketone (PEEK) interbody cages (IBCs) have been introduced to overcome any disadvantages. The purpose of this study was to investigate the radiological outcomes of lumbar interbody fusion (LIF) surgery using the Ti-coated PEEK IBC with a minimum of 1-year of follow-up. METHODS A total of 26 intervertebral spaces in consecutive 21 patients who underwent posterior/transforaminal LIF using the Ti-coated PEEK IBC were evaluated. Rates of bone union, screw loosening, cage subsidence and bone cyst formation around the endplate were evaluated on computed tomography scans acquired at least 1 year postoperatively. RESULTS AND DISCUSSION At the 1-year follow-up, bone fusion was achieved in 23 (88.4%) of 26 intervertebral spaces. Cagesubsidence was found in 5 intervertebral spaces ; however,bone fusion was achieved in all these spaces. Bone cysts formed in 4 intervertebral spaces and 4 of 94 screws were found to be loosened. Three of the loosened screws were found in vertebral bodies adjacent to intervertebral spaces with nonunion. However, there was no association between these events. Although more scientific evidence is required to determine the advantages of Ti-coated PEEK IBCs, we believe the clinical outcomes achieved were favorable at the 1 year minimum follow-up. J. Med. Invest. 66 : 119-122, February, 2019.
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Affiliation(s)
- Hiroaki Manabe
- Department of Orthopedics, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
| | - Toshinori Sakai
- Department of Orthopedics, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
| | - Masatoshi Morimoto
- Department of Orthopedics, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
| | - Fumitake Tezuka
- Department of Orthopedics, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
| | - Kazuta Yamashita
- Department of Orthopedics, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
| | - Yoichiro Takata
- Department of Orthopedics, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
| | - Koichi Sairyo
- Department of Orthopedics, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
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23
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Wu WJ, Li Y, Hou TY, Cheng P, Zhang ZH, Xu JZ, Luo F. Application of New Allogeneic Lumbar Fusion Cage (Biocage) in Single-Segment Lumbar Degenerative Disease: A Prospective Controlled Study with Follow-Up for ≥2 Years. World Neurosurg 2019; 126:e1309-e1314. [PMID: 30898751 DOI: 10.1016/j.wneu.2019.03.084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 03/08/2019] [Accepted: 03/09/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVE We evaluated the clinical efficacy of the Biocage in lumbar fusion surgery and its safety and effectiveness. METHODS A total of 431 patients with single-segment lumbar degenerative disease diagnosed from January 2013 to December 2016 were considered for the present prospective, nonrandomized, and controlled study; 52 patient met the exclusion criteria and were excluded. The patients were divided into 2 groups according to their cage choice: Biocage (n = 206) and polyether ether ketone (PEEK) cage (n = 173). The patients were followed up for 24-48 months (average, 32). The operative time, blood loss, hospitalization duration, mean intervertebral fusion segment height, height of intervertebral foramen, fusion time, fusion rate, internal fixation failure rate, visual analog scale score, and Oswestry disability index were compared between the 2 groups. RESULTS All the patients underwent surgery successfully. No significant differences were found in gender, age, clinical diagnosis, lesion segment, operative time, blood loss, visual analog scale score, or Oswestry disability index between the 2 groups. No significant differences were found in the fusion rate; however, the Biocage group had a greater fusion rate and shorter fusion time than the PEEK group. During follow-up, the mean intervertebral height recovered significantly in the Biocage group compared with the PPEK group (P < 0.05). The height of the intervertebral foramen was significantly different between the 2 groups, and recovery was better in the Biocage group (P < 0.05). The Cobb angle of fusion segment in both groups improved significantly postoperatively compared with preoperatively (P < 0.05). The improvement in Cobb angle was significantly different between the 2 groups (P < 0.05). CONCLUSIONS The Biocage has excellent clinical efficacy in the treatment of lumbar degenerative disease. Although the Biocage achieved good therapeutic effects, it did not show obvious advantages compared with the PEEK cage. Therefore, the Biocage can only be used as a choice of bone graft materials for lumbar fusion surgery and should not completely replace the PEEK cage.
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Affiliation(s)
- Wen-Jie Wu
- National and Regional Engineering Laboratory of Tissue Engineering, Department of Orthopedics, First Hospital Affiliated to Army Military University (Southwest Hospital), Chongqing, China
| | - Yang Li
- National and Regional Engineering Laboratory of Tissue Engineering, Department of Orthopedics, First Hospital Affiliated to Army Military University (Southwest Hospital), Chongqing, China
| | - Tian-Yong Hou
- National and Regional Engineering Laboratory of Tissue Engineering, Department of Orthopedics, First Hospital Affiliated to Army Military University (Southwest Hospital), Chongqing, China
| | - Peng Cheng
- National and Regional Engineering Laboratory of Tissue Engineering, Department of Orthopedics, First Hospital Affiliated to Army Military University (Southwest Hospital), Chongqing, China
| | - Ze-Hua Zhang
- National and Regional Engineering Laboratory of Tissue Engineering, Department of Orthopedics, First Hospital Affiliated to Army Military University (Southwest Hospital), Chongqing, China
| | - Jian-Zhong Xu
- National and Regional Engineering Laboratory of Tissue Engineering, Department of Orthopedics, First Hospital Affiliated to Army Military University (Southwest Hospital), Chongqing, China
| | - Fei Luo
- National and Regional Engineering Laboratory of Tissue Engineering, Department of Orthopedics, First Hospital Affiliated to Army Military University (Southwest Hospital), Chongqing, China.
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Freitag L, Günther C, Eberli U, Fürst A, Zeiter S, Stadelmann VA. Relative effects of age on implant integration in a rat model: A longitudinal in vivo microct study. J Orthop Res 2019; 37:541-552. [PMID: 30575124 DOI: 10.1002/jor.24210] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 12/11/2018] [Indexed: 02/04/2023]
Abstract
The effect of age on implant fixation in bone is not always considered during the design of preclinical models. The decision on animal's age is often related to practical or historical reasons, which ultimately may affect the reproducibility of results. This study aimed to quantify the effect of age by monitoring the fixation of contrast-enhanced PEEK screws in rats, hypothesizing that the kinetics of fixation is impaired in older animals but that age effects are less severe than osteoporotic effects. The time course of implant fixation was investigated in healthy rats at 24, 40, and 60 weeks of age; and in ovariectomized rats. Implant fixation was monitored using in-vivo microCT and dynamic histomorphometry during 1 month. The rats were euthanized 28 days post screw insertion. The data was analyzed both in absolute value and after normalization to baseline bone mass. In absolute terms, greater age had a detrimental effect on bone implant contact, bone fraction, implant stiffness, and bone remodeling but less than ovariectomy. Interestingly, once data was normalized to baseline bone mass this effect disappeared, suggesting that the physiologic response to implant placement was not affected by age. In conclusion, implant fixation kinetics is less affected by age than by baseline bone mass in this rat model. Animals of different ages can therefore be compared but data must be construed relatively to baseline bone mass and not in absolute terms. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 9999:1-12, 2018.
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Affiliation(s)
| | - Christian Günther
- AO Research Institute Davos, Davos, Switzerland.,Klinik für Pferdechirurgie, Vetsuisse-Fakultät der Universität Zürich, Zürich, Switzerland
| | | | - Anton Fürst
- Klinik für Pferdechirurgie, Vetsuisse-Fakultät der Universität Zürich, Zürich, Switzerland
| | | | - Vincent A Stadelmann
- AO Research Institute Davos, Davos, Switzerland.,Schulthess Clinic, Department of Research and Development, Zürich, Switzerland
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Cuzzocrea F, Ivone A, Jannelli E, Fioruzzi A, Ferranti E, Vanelli R, Benazzo F. PEEK versus metal cages in posterior lumbar interbody fusion: a clinical and radiological comparative study. Musculoskelet Surg 2018; 103:237-241. [PMID: 30536223 DOI: 10.1007/s12306-018-0580-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Accepted: 12/01/2018] [Indexed: 02/08/2023]
Abstract
BACKGROUND Low back pain and sciatica represent a common disabling condition with a significant impact on the social, working and economic lives of patients. Transforaminal lumbar interbody fusion (TLIF) is a surgical procedure used in degenerative spine conditions. Several types of cages were used in the TLIF procedure. PURPOSE To determine whether there is a difference in terms of symptomatology improvement, return to daily activities and fusion rate between metal cages and polyetheretherketone (PEEK) cages. METHODS We have retrospectively reviewed 40 patients who have undergone TLIF from October 2015 to May 2016. All patients were clinically evaluated with questionnaires and were assessed with CT scan and standing X-ray films of the full-length spine. RESULTS We found no significant functional differences in the two groups. At 1-year follow-up, osteolysis was present in 50% of cases of the PEEK cages and in 10% cases of the metal cages. The degree of fusion at 1 year was evaluated as complete in 40% cases of the metal cages and 15% cases of the PEEK cages. CONCLUSIONS We have found a better fusion rate and prevalence of fusion in the group treated with metal cages, reflecting the well-known osteoinductive properties of titanium and tantalum.
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Affiliation(s)
- F Cuzzocrea
- S.C. Ortopedia e Traumatologia, IRCCS Policlinico San Matteo, Università degli Studi di Pavia, Viale Camillo Golgi 19, 27100, Pavia, PV, Italy
| | - A Ivone
- S.C. Ortopedia e Traumatologia, IRCCS Policlinico San Matteo, Università degli Studi di Pavia, Viale Camillo Golgi 19, 27100, Pavia, PV, Italy.
| | - E Jannelli
- S.C. Ortopedia e Traumatologia, IRCCS Policlinico San Matteo, Università degli Studi di Pavia, Viale Camillo Golgi 19, 27100, Pavia, PV, Italy
| | - A Fioruzzi
- S.C. Ortopedia e Traumatologia, IRCCS Policlinico San Matteo, Università degli Studi di Pavia, Viale Camillo Golgi 19, 27100, Pavia, PV, Italy
| | - E Ferranti
- S.C. Ortopedia e Traumatologia, IRCCS Policlinico San Matteo, Università degli Studi di Pavia, Viale Camillo Golgi 19, 27100, Pavia, PV, Italy
| | - R Vanelli
- S.C. Ortopedia e Traumatologia, IRCCS Policlinico San Matteo, Università degli Studi di Pavia, Viale Camillo Golgi 19, 27100, Pavia, PV, Italy
| | - F Benazzo
- S.C. Ortopedia e Traumatologia, IRCCS Policlinico San Matteo, Università degli Studi di Pavia, Viale Camillo Golgi 19, 27100, Pavia, PV, Italy
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26
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Makino T, Kaito T, Sakai Y, Takenaka S, Yoshikawa H. Computed tomography color mapping for evaluation of bone ongrowth on the surface of a titanium-coated polyetheretherketone cage in vivo: A pilot study. Medicine (Baltimore) 2018; 97:e12379. [PMID: 30213002 PMCID: PMC6155981 DOI: 10.1097/md.0000000000012379] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Bone ongrowth on the surfaces of titanium (Ti)-coated polyetheretherketone (PEEK) materials has been demonstrated in animal models; however, whether this occurs on the surfaces of Ti-coated PEEK cages in lumbar interbody fusion has not been demonstrated clinically in vivo. This prospective observational study was aimed to develop and validate a computed tomography (CT) color mapping based on Hounsfield unit (HU) values for evaluation of bone ongrowth on the surfaces of the Ti-coated PEEK cage after posterior lumbar interbody fusion (PLIF).Twenty-four consecutive patients (11 men and 13 women; mean age, 67.0 years; range, 20-82 years) who underwent single- or 2-level PLIF since March 2015 were included. Two Ti-coated PEEK cages were inserted in all PLIF segments. From reconstructed sagittal planes from postoperative CT scans (within 1 week and 6 months postoperatively), bone ongrowth on the surfaces of cage frames was evaluated by CT color mapping. Inter- and intraobserver reliability of the assessment of bone ongrowth by CT color mapping was evaluated by Cohen's kappa coefficient. The relation between CT color mapping and HU values on the surfaces of cage frames was also analyzed.A total of 248 surfaces of cage frames were evaluated. Bone ongrowth was observed in 134 of 248 surfaces (54.0%) by CT color mapping. Intraobserver reliability for the evaluation of bone ongrowth was kappa = 0.831, and interobserver reliability was kappa = 0.713. The HU values in the local regions of interest (ROIs) on the surfaces of cage frames where the postoperative bone ongrowth existed on CT color mapping increased significantly postoperatively (P < .001), and the median postoperative change rate of the HU values in the local ROIs was 22.4%.The assessment of bone ongrowth on the surfaces of Ti-coated PEEK cages by CT color mapping had adequate inter- and intraobserver reliability, which was useful especially in detecting local increase in HU values on the surfaces of the cages. This method is an easy and visually comprehensible method for the assessment of bone ongrowth in the bone-implant interface.
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Affiliation(s)
- Takahiro Makino
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
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27
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Sexual activity after spine surgery: a systematic review. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2018; 27:2395-2426. [PMID: 29796731 DOI: 10.1007/s00586-018-5636-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 05/13/2018] [Indexed: 01/07/2023]
Abstract
INTRODUCTION Sexual function is an important determinant of quality of life, and factors such as surgical approach, performance of fusion, neurological function and residual pain can affect it after spine surgery. Our aim was to perform a systematic review to collate evidence regarding the impact of spine surgery on sexual function. METHODS A systematic review of studies reporting measures of sexual function, and incidence of adverse sexual outcomes (retrograde ejaculation) after major spine surgery was done, regardless of spinal location. Pubmed (MEDLINE) and Google Scholar databases were queried using the following search words "Sex", "Sex life", "Sexual function", "Sexual activity", "retrograde ejaculation", "Spine", "Spine surgery", "Lumbar surgery", "Lumbar fusion", "cervical spine", "cervical fusion", "Spinal deformity", "scoliosis" and "Decompression". All articles published between 1997 and 2017 were retrieved from the database. A total of 81 studies were included in the final review. RESULTS Majority of the studies were retrospective case series and were low quality (Level IV) in evidence. Anterior lumbar approaches were associated with a higher incidence of retrograde ejaculation, especially with the utilization of transperitoneal laparoscopic approach. There is inconclusive evidence on the preferred sexual position following fusion, and also on the impact of BMP-2 usage on retrograde ejaculation/sexual dysfunction. CONCLUSION Despite limited evidence from high-quality articles, there is a general trend towards improvement of sexual activity and function after spine surgery. Future studies incorporating specific assessments of sexual activity will be required to address this important determinant of quality of life so that appropriate pre-operative counselling can be done by providers. These slides can be retrieved under Electronic Supplementary Material.
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28
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Tschugg A, Kavakebi P, Hartmann S, Lener S, Wipplinger C, Löscher WN, Neururer S, Wildauer M, Thomé C. Clinical and radiological effect of medialized cortical bone trajectory for lumbar pedicle screw fixation in patients with degenerative lumbar spondylolisthesis: study protocol for a randomized controlled trial (mPACT). Trials 2018; 19:129. [PMID: 29463278 PMCID: PMC5819638 DOI: 10.1186/s13063-018-2504-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Accepted: 01/29/2018] [Indexed: 12/26/2022] Open
Abstract
Background Spinal fusion with pedicle screw fixation represents the gold standard for lumbar degenerative disc disease with instability. Although it is an established technique, it is nevertheless an invasive intervention with high complication rates. Therefore, minimally invasive approaches have been developed, the medialized bilateral screw pedicel fixation (mPACT) being one of them. The study objective is to evaluate prospectively the efficacy and safety of the mPACT technique compared with the traditional trajectory for degenerative lumbar spondylolisthesis. Methods/design This is a single-center, randomized, controlled, parallel group, superiority trial. A total of 154 adult patients are allocated in a ratio of 1:1. Sample size and power calculation were performed to detect the minimal clinically important difference of 10%, with an expected standard deviation of 20% in the primary outcome parameter, the Oswestry Disability Index, with power of 80%, based on an assumed maximal dropout rate of 20%. Secondary outcome parameters include the EuroQoL 5-Dimension questionnaire, the Beck Depression Inventory, the painDETECT questionnaire and the “timed up and go” test. Furthermore, radiological and health economic outcomes will be evaluated. Follow up is performed until 5 years after surgery. Major inclusion criteria are lumbar degenerative spondylolisthesis with Meyerding grade I or II, which qualifies for decompression and fusion by medialised posterior screw placement with cortical trajectory (mPACT) or by a traditional trajectory for lumbar pedicle screw placement. Discussion This trial will contribute to the understanding of the short-term and long-term clinical and radiological postoperative course in patients with lumbar degenerative disc disease, in which the mPACT technique is used. Trial registration ISRCTN registry, ISRCTN99263604. Registered on 3 November 2016. Electronic supplementary material The online version of this article (10.1186/s13063-018-2504-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Anja Tschugg
- Department of Neurosurgery, Medical University of Innsbruck, Anichstr. 35, A-6020, Innsbruck, Austria.
| | - Pujan Kavakebi
- Department of Neurosurgery, Medical University of Innsbruck, Anichstr. 35, A-6020, Innsbruck, Austria
| | - Sebastian Hartmann
- Department of Neurosurgery, Medical University of Innsbruck, Anichstr. 35, A-6020, Innsbruck, Austria
| | - Sara Lener
- Department of Neurosurgery, Medical University of Innsbruck, Anichstr. 35, A-6020, Innsbruck, Austria
| | - Christoph Wipplinger
- Department of Neurosurgery, Medical University of Innsbruck, Anichstr. 35, A-6020, Innsbruck, Austria
| | - Wolfgang N Löscher
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Sabrina Neururer
- Department of Medical Statistics, Informatics and Health Economics, Medical University of Innsbruck, Innsbruck, Austria
| | - Matthias Wildauer
- Department of Neuroradiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Claudius Thomé
- Department of Neurosurgery, Medical University of Innsbruck, Anichstr. 35, A-6020, Innsbruck, Austria
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Rao PJ, Phan K, Giang G, Maharaj MM, Phan S, Mobbs RJ. Subsidence following anterior lumbar interbody fusion (ALIF): a prospective study. JOURNAL OF SPINE SURGERY 2017; 3:168-175. [PMID: 28744497 DOI: 10.21037/jss.2017.05.03] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND Anterior lumbar interbody fusion (ALIF) is a widely used surgical technique for disorders of the lumbar spine. One potential complication is the subsidence of disc height in the post-operative period. Few studies have reported the rate of subsidence in ALIF surgery prospectively. We prospectively evaluated the rate of subsidence in adult patients undergoing ALIF. METHODS Results were obtained by reviewing scans of 147 patients. Disc heights were measured on radiographic scans taken pre-operatively in addition to post-operatively immediately, at 6 weeks and at 18 months. The anterior and posterior intervertebral disc heights were measured. Subsidence was defined as greater than or equal to 2 mm loss of height. RESULTS A total of 15 patients (10.2%) had subsidence, with 7 being male. Each case was of delayed cage subsidence (DCS) >6 weeks postoperatively. The mean subsidence was 4.7 mm (range, 2.4-7.8). Mean anterior disc height was 8.6±0.4 mm preoperatively, which improved to 15.1±0.5 mm at latest follow-up. Mean posterior disc height was 4.7±0.2 mm preoperatively, which improved to 8.7±0.4 mm at latest follow-up. The mean lumbar lordosis (LL) angle was 42.5°±10.8° and the mean local disc angle (LDA) was 6.7°±4.0°. The 91.2% (n=114/125) of patients with appropriate radiological follow-up demonstrated fusion by latest follow-up. There was no correlation between subsidence rate with patient reported outcomes [Visual Analog Scale (VAS), Oswestry Disability Index (ODI) and Short Form 12 Item survey (SF-12)] and fusion rates. There was a significant negative correlation between LL and extent of subsidence (Pearson correlation =-0.754, P=0.012). CONCLUSIONS In conclusion, we found that the subsidence rate at follow-up was generally low following standalone ALIF for this patient series. Patient clinical outcomes and bony fusion rates were not significantly influenced by subsidence.
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Affiliation(s)
- Prashanth J Rao
- NeuroSpine Surgery Research Group (NSURG), Prince of Wales Private Hospital, Sydney, Australia.,University of New South Wales (UNSW), Sydney, Australia
| | - Kevin Phan
- NeuroSpine Surgery Research Group (NSURG), Prince of Wales Private Hospital, Sydney, Australia.,University of New South Wales (UNSW), Sydney, Australia.,Faculty of Medicine, University of Sydney, Sydney, Australia
| | - Gloria Giang
- NeuroSpine Surgery Research Group (NSURG), Prince of Wales Private Hospital, Sydney, Australia.,University of New South Wales (UNSW), Sydney, Australia
| | - Monish M Maharaj
- NeuroSpine Surgery Research Group (NSURG), Prince of Wales Private Hospital, Sydney, Australia.,University of New South Wales (UNSW), Sydney, Australia
| | - Steven Phan
- NeuroSpine Surgery Research Group (NSURG), Prince of Wales Private Hospital, Sydney, Australia.,Faculty of Medicine, University of Sydney, Sydney, Australia
| | - Ralph J Mobbs
- NeuroSpine Surgery Research Group (NSURG), Prince of Wales Private Hospital, Sydney, Australia.,University of New South Wales (UNSW), Sydney, Australia
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30
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Wang N, Xie H, Xi C, Zhang H, Yan J. A study to compare the efficacy of polyether ether ketone rod device with titanium devices in posterior spinal fusion in a canine model. J Orthop Surg Res 2017; 12:40. [PMID: 28279204 PMCID: PMC5345138 DOI: 10.1186/s13018-017-0543-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Accepted: 02/25/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The benefits of posterior lumbar fusion surgery with orthotopic paraspinal muscle-pediculated bone flaps are well established. However, the problem of non-union due to mechanical support is not completely resolved. The aim of the study was to compare the efficacy of polyether ether ketone (PEEK) rod device with conventional titanium devices in the posterior lumbar fusion surgery with orthotopic paraspinal muscle-pediculated bone flaps. METHODS This was a randomized controlled study with an experimental animal model. Thirty-two mongrel dogs were randomly divided into two groups-control group (n = 16), which received the titanium device and the treatment group (n = 16), which received PEEK rods. The animals were sacrificed 8 or 16 weeks after surgery. Lumbar spines of dogs in both groups were removed, harvested, and assessed for radiographic, biomechanical, and histological changes. RESULTS Results in the current study indicated that there was no significant difference in the lumbar spine of the control and treatment groups in terms of radiographic, manual palpation, and gross examination. However, certain parameters of biomechanical testing showed significant differences (p < 0.05) in stiffness and displacement, revealing a better fusion (treatment group showed decreased stiffness with decreased displacement) of the bone graft. Similarly, the histological analysis also revealed a significant fusion mass in both treatment and control groups (p < 0.05). CONCLUSIONS These findings revealed that fixation using PEEK connecting rod could improve the union of the bone graft in the posterior lumbar spine fusion surgery compared with that of the titanium rod fixation.
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Affiliation(s)
- Nanxiang Wang
- Department of Orthopaedics, The Second Affiliated Hospital of Harbin Medical University, Harbin, 150081, China
| | - Huanxin Xie
- Department of Orthopaedics, The Second Affiliated Hospital of Harbin Medical University, Harbin, 150081, China
| | - Chunyang Xi
- Department of Orthopaedics, The Second Affiliated Hospital of Harbin Medical University, Harbin, 150081, China
| | - Han Zhang
- Department of Orthopaedics, The Second Affiliated Hospital of Harbin Medical University, Harbin, 150081, China
| | - Jinglong Yan
- Department of Orthopaedics, The Second Affiliated Hospital of Harbin Medical University, Harbin, 150081, China.
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Liu X, Ma J, Park P, Huang X, Xie N, Ye X. Biomechanical comparison of multilevel lateral interbody fusion with and without supplementary instrumentation: a three-dimensional finite element study. BMC Musculoskelet Disord 2017; 18:63. [PMID: 28153036 PMCID: PMC5290599 DOI: 10.1186/s12891-017-1387-6] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Accepted: 01/03/2017] [Indexed: 11/10/2022] Open
Abstract
Background Lateral lumbar interbody fusion (LLIF) is a popular, minimally invasive technique that is used to address challenging multilevel degenerative spinal diseases. It remains controversial whether supplemental instrumentation should be added for multilevel LLIF. In this study, we compared the kinematic stability afforded by stand-alone lateral cages with those supplemented by bilateral pedicle screws and rods (PSR), unilateral PSR, or lateral plate (LP) fixation using a finite-element (FE) model of a multi-level LLIF construct with simulated osteoporosis. Additionally, to evaluate the prospect of cage subsidence, the stress change characteristics were surveyed at cage-endplate interfaces. Methods A nonlinear 3-dimensional FE model of the lumbar spine (L2 to sacrum) was used. After validation, four patterns of instrumented 3-level LLIF (L2-L5) were constructed for this analysis: (a) 3 stand-alone lateral cages (SLC), (b) 3 lateral cages with lateral plate and two screws (parallel to endplate) fixated separately (LPC), (c) 3 lateral cages with bilateral pedicle screw and rod fixation (LC + BPSR), and (d) 3 lateral cages with unilateral pedicle and rod fixation (LC + UPSR). The segmental and overall range of motion (ROM) of each implanted condition were investigated and compared with the intact model. The peak von Mises stresses upon each (superior) endplate and the stress distribution were used for analysis. Results BPSR provided the maximum reduction of ROM among the configurations at every plane of motion (66.7–90.9% of intact spine). UPSR also provided significant segmental ROM reduction (45.0–88.3%). SLC provided a minimal restriction of ROM (10.0–75.1%), and LPC was found to be less stable than both posterior fixation (23.9–86.2%) constructs. The construct with stand-alone lateral cages generated greater endplate stresses than did any of the other multilevel LLIF models. For the L3, L4 and L5 endplates, peak endplate stresses caused by the SLC construct exceeded the BPSR group by 52.7, 63.8, and 54.2% in flexion, 22.3, 40.1, and 31.4% in extension, 170.2, 175.1, and 134.0% in lateral bending, and 90.7, 45.5, and 30.0% in axial rotation, respectively. The stresses tended to be more concentrated at the periphery of the endplates. Conclusions SLC and LPC provided inadequate ROM restriction for the multilevel LLIF constructs, whereas lateral cages with BPSR or UPSR fixation provided favorable biomechanical stability. Moreover, SLC generated significantly higher endplate stress compared with supplemental instrumentation, which may have increased the risk of cage subsidence. Further biomechanical and clinical studies are required to validate our FEA findings. Electronic supplementary material The online version of this article (doi:10.1186/s12891-017-1387-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Xilin Liu
- Department of Orthopedics, Changzheng Hospital, Second Military Medical University, 415 Fengyang Road, Shanghai, 200003, China
| | - Jun Ma
- Department of Orthopedics, Changzheng Hospital, Second Military Medical University, 415 Fengyang Road, Shanghai, 200003, China
| | - Paul Park
- Department of Neurosurgery, University of Michigan, 1500 E Medical Center Dr, Ann Arbor, MI, 48109, USA
| | - Xiaodong Huang
- Department of Orthopedics, Changzheng Hospital, Second Military Medical University, 415 Fengyang Road, Shanghai, 200003, China
| | - Ning Xie
- Department of Orthopedics, Changzheng Hospital, Second Military Medical University, 415 Fengyang Road, Shanghai, 200003, China.
| | - Xiaojian Ye
- Department of Orthopedics, Changzheng Hospital, Second Military Medical University, 415 Fengyang Road, Shanghai, 200003, China.
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Sclafani JA, Bergen SR, Staples M, Liang K, Raiszadeh R. Arthrodesis Rate and Patient Reported Outcomes After Anterior Lumbar Interbody Fusion Utilizing a Plasma-Sprayed Titanium Coated PEEK Interbody Implant: A Retrospective, Observational Analysis. Int J Spine Surg 2017; 11:4. [PMID: 28377862 DOI: 10.14444/4004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Anterior lumbar interbody fusion (ALIF) is utilized in symptomatic spinal disc destabilization due to degenerative lumbar disc disease, isthmic and degenerative spondylolisthesis, internal disc disruption, or pseudarthrosis after non-operative treatments fail. The addition of a plasma-sprayed titanium coating (PTC) to polyether ether ketone spacers (PEEK) may reduce the rate of implant subsidence or non-union secondary to poor osseous-integration of non-coated PEEK or metal interbody systems. METHODS A retrospective, non-randomized, single-center chart review, evaluated the post-surgical follow-up data of patients receiving a PTC PEEK implant during single or multi-level ALIF procedures to determine the clinical efficacy and rate of arthrodesis after utilization of a coated spacer. Standard roentgenographs or computed tomography were used to identify successful arthrodesis following the ALIF procedure and longitudinal clinical improvements were determined by scores on the Visual Analog Scale (VAS) for low back and leg pain. RESULTS Forty-four subjects (48% male, mean=53 years) were included in this chart review. Follow-up radiology demonstrated radiographic union with bridging bone formation across the interbody space for 42/44 (96%) individuals with solid arthrodesis occurring at an average of 7.3 ± 2.3 months. Subjects demonstrated significant improvement in VAS low back pain (4.5 ± 2.4 point improvement, p=0.0001) and VAS leg pain (4.1 ± 3.3 point improvement, p=0.0001). While there was a significant reduction in the improvement of VAS low back pain of Worker's Compensation claimants as compared to other patients (3.9 ± 2.4 vs. 5.3 ± 2.1), there was no difference in VAS low back pain or leg pain when the data was stratified by gender, age, tobacco use, comorbidities, prior surgery, fusion construct length, use of supplemental posterior instrumentation, BMI, or diagnosis. CONCLUSIONS This study provides support that the addition of a PTC coating to a zero-profile PEEK lumbar interbody spacer facilitates rapid and stable fixation at the bone-implant interface. This facilitated osteogenesis is associated with significantly improved pain outcomes, low implant subsidence and a high definitive rate of arthrodesis. Future studies should include a prospective, randomized, controlled, multi-center approach to directly compare arthrodesis rates and clinical outcomes longitudinally between standard PEEK and biomaterial-coated PEEK interbody spacer systems.
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Affiliation(s)
- Joseph A Sclafani
- Spine Institute of San Diego, Minimally Invasive Spine Center of Excellence, San Diego, CA; Milestone Research Organization, San Diego, CA
| | - Sophea R Bergen
- Spine Institute of San Diego, Minimally Invasive Spine Center of Excellence, San Diego, CA
| | | | - Kevin Liang
- Milestone Research Organization, San Diego, CA
| | - Ramin Raiszadeh
- Spine Institute of San Diego, Minimally Invasive Spine Center of Excellence, San Diego, CA
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Phan K, Mobbs RJ. Evolution of Design of Interbody Cages for Anterior Lumbar Interbody Fusion. Orthop Surg 2016; 8:270-7. [PMID: 27627708 PMCID: PMC6584298 DOI: 10.1111/os.12259] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Accepted: 02/13/2016] [Indexed: 11/28/2022] Open
Abstract
Anterior lumbar interbody fusion (ALIF) is one of the surgical procedures for the relief of chronic back pain, radiculopathy and neurogenic claudication in patients with degenerative lumbar spine disease that is refractory to conservative therapy, low-grade spondylolisthesis and pseudo arthrosis. Over the past half century, both the surgical techniques and instrumentation required for ALIF have changed significantly. In particular, the designs of ALIF cage and the materials used have evolved dramatically, the common goal being to improve fusion rates and optimize clinical outcomes. The increasing popularity of ALIF is reflected by the increasing abundance of published studies reporting clinical outcomes, surgical techniques and grafting options for ALIF. Developments in cage designs include cylindrical Bagby and Kuslich, cylindrical ray, cylindrical mesh, lumbar-tapered, polyethyl-etherketone cage and integral fixation cages. Biologic implants include bone dowels and femoral ring allografts. Methods for optimization of cage design have included cage dimensions, use of novel composite cage materials and integral fixation technologies. However, the historical development and evolution of cages used for ALIF has not been extensively documented. This article therefore aims to provide an overview of the historical basis for the anterior approach, evolution in design of ALIF cage implants and potential future research directions.
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Affiliation(s)
- Kevin Phan
- Department of Neurosurgery, NeuroSpine Surgery Research Group, Prince of Wales Private Hospital, Sydney, Australia
- Department of Neurosurgery, University of New South Wales, Sydney, Australia
- Department of Neurosurgery, Prince of Wales Hospital, Sydney, Australia
| | - Ralph J Mobbs
- Department of Neurosurgery, NeuroSpine Surgery Research Group, Prince of Wales Private Hospital, Sydney, Australia.
- Department of Neurosurgery, University of New South Wales, Sydney, Australia.
- Department of Neurosurgery, Prince of Wales Hospital, Sydney, Australia.
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Anterior stand-alone fusion revisited: a prospective clinical, X-ray and CT investigation. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2014; 24:838-51. [DOI: 10.1007/s00586-014-3642-y] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Revised: 10/26/2014] [Accepted: 10/27/2014] [Indexed: 11/26/2022]
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Stein IC, Than KD, Chen KS, Wang AC, Park P. Failure of a polyether-ether-ketone expandable interbody cage following transforaminal lumbar interbody fusion. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2014; 24 Suppl 4:S555-9. [PMID: 25465905 DOI: 10.1007/s00586-014-3704-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Revised: 11/24/2014] [Accepted: 11/26/2014] [Indexed: 12/28/2022]
Abstract
PURPOSE Expandable cages are a more recent option for maintaining or restoring disc height and segmental lordosis with transforaminal lumbar interbody fusion (TLIF). Complications associated with expandable cages have not yet been widely reported. We report a case of postoperative failure of a polyether-ether-ketone (PEEK) expandable interbody device used during TLIF. METHODS A 50-year-old man presented with severe back and right leg pain after undergoing L4-5 and L5-S1 TLIFs with expandable cages and L3-S1 posterior instrumented fusion. Imaging showed retropulsion of a portion of the interbody cage into the spinal canal causing nerve compression. Displacement occurred in a delayed manner. In addition, pseudoarthrosis was present. RESULTS The patient underwent re-exploration with removal of the retropulsed wafer and redo fusion. CONCLUSIONS Expandable cages are a recent innovation; as such, efficacy and complication data are limited. As with any new device, there exists potential for mechanical failure, as occurred in the case presented.
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Affiliation(s)
- Isaac C Stein
- University of Michigan Medical School, Ann Arbor, MI, USA
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Hak DJ, Mauffrey C, Seligson D, Lindeque B. Use of carbon-fiber-reinforced composite implants in orthopedic surgery. Orthopedics 2014; 37:825-30. [PMID: 25437074 DOI: 10.3928/01477447-20141124-05] [Citation(s) in RCA: 84] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2014] [Accepted: 10/22/2014] [Indexed: 02/03/2023]
Abstract
Carbon-fiber-reinforced polyetheretherketone implants offer several benefits over traditional metal implants. Their radiolucent property permits improved, artifact-free radiographic imaging. Their lower modulus of elasticity better matches that of bone. Their fatigue strength is greater than most metal implants. This article reviews the use of these implants in orthopedic surgery, including treatment of conditions involving the spine, trauma, tumor, and infection.
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Silva-Correia J, Correia SI, Oliveira JM, Reis RL. Tissue engineering strategies applied in the regeneration of the human intervertebral disk. Biotechnol Adv 2013; 31:1514-31. [DOI: 10.1016/j.biotechadv.2013.07.010] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2012] [Revised: 07/12/2013] [Accepted: 07/26/2013] [Indexed: 01/03/2023]
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Behrbalk E, Uri O, Parks RM, Musson R, Soh RCC, Boszczyk BM. Fusion and subsidence rate of stand alone anterior lumbar interbody fusion using PEEK cage with recombinant human bone morphogenetic protein-2. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2013; 22:2869-75. [PMID: 23955421 DOI: 10.1007/s00586-013-2948-5] [Citation(s) in RCA: 70] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2013] [Revised: 07/22/2013] [Accepted: 08/03/2013] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Anterior lumbar interbody fusion (ALIF) is an established treatment for structural instability associated with symptomatic disk degeneration (SDD). Stand-alone ALIF offers many advantages, however, it may increase the risk of non-union. Recombinant human bone morphogenetic protein-2 (BMP-2) may enhance fusion rate but is associated with postoperative complication. The optimal dose of BMP-2 remains unclear. This study assessed the fusion and subsidence rates of stand-alone ALIF using the SynFix-LR interbody cage with 6 ml/level of BMP-2. METHODS Thirty-two ALIF procedures were performed by a single surgeon in 25 patients. Twenty-five procedures were performed for SDD without spondylolisthesis (SDD group) and seven procedures were performed for SDD with grade-I olisthesis (SDD-olisthesis group). Patients were followed-up for a mean of 17 ± 6 months. RESULTS Solid fusion was achieved in 29 cases (90.6 %) within 6 months postoperatively. Five cases of implant subsidence were observed (16 %). Four of these occurred in the SDD-olisthesis group and one occurred in the SDD group (57 % vs. 4 % respectively; p = 0.004). Three cases of subsidence failed to fuse and required revision. The body mass index of patients with olisthesis who developed subsidence was higher than those who did not develop subsidence (29 ± 2.6 vs. 22 ± 6.5 respectively; p = 0.04). No BMP-2 related complications occurred. CONCLUSION The overall fusion rate of stand-alone ALIF using the SynFix-LR system with BMP-2 was 90.6 %, comparable with other published series. No BMP-2 related complication occurred at a dose of 6 mg/level. Degenerative spondylolisthesis and obesity seemed to increase the rate of implant subsidence, and thus we believe that adding posterior fusion for these cases should be considered.
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Affiliation(s)
- Eyal Behrbalk
- The Spine Unit, Queen's Medical Centre, Nottingham, UK,
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