J Korean Soc Spine Surg.  2011 Dec;18(4):230-238. 10.4184/jkss.2011.18.4.230.

Efficacy of Posterior Lumbar Interbody Fusion using PEEK Cage and Pedicle Screw Stabilization in Degenerative Lumbar Spinal Disorders: Minimum 3 Years Follow up Results

• Song KJ
• Lee KB
• Ham DH

• KMID: 1448001
• DOI: http://doi.org/10.4184/jkss.2011.18.4.230

Abstract

STUDY DESIGN: A retrospective study.
OBJECTIVES
To evaluate the three-plus year follow-up results of patients who underwent posterior lumbar interbody fusion with PEEK cage and pedicle screw fixation for lumbar degenerative disease. SUMMARY OF LITERATURE REVIEW: There are few previous reports addressing posterior lumbar interbody fusion using PEEK cage with mid-term follow up periods.
MATERIALS AND METHODS
260 patients who underwent posterior lumbar interbody fusion with PEEK cage and pedicle screw fixation for lumbar degenerative disease were enrolled. We classified patients into three groups according to their fusion level: group A (n=151) had one-level fusion, and group B (n=91) had two-level fusion, and group C (n=18) had three-level fusion. Clinical outcomes were evaluated by pre- and post-operative Visual analogue scale (VAS) scores, the Oswestry Disability Index (ODI), and complication and reoperation rates. Radiologic outcomes were measured by the fusion rate, sagittal alignment, disc height and changes.
RESULTS
VAS (pre-operative to final follow-up) changed from 7.62+/-2.03 (5-10) to 3.19+/-1.94 (1-8) in group A, from 6.83+/-2.28(4-9) to 4.51+/-2.18(2-9) in group B and from 7.17+/-2.46 (5-10) to 4.63+/-1.97(1-9) in group C. Final follow-up ODI also decreased in group A (17.6+/-8.56%), group B (15.4+/-5.46%) and group C (24.7+/-7.46%). This corresponds to scores of 94.7% in group A, 92.3% in group B and 94.4% in group C. There were significant differences between preoperative, post-operative and final follow-up lumbar lordosis [p=0.042(group A), 0.036(group B), 0.045(group C)], segmental lordosis [p=0.036(group A), 0.039(group B), 0.047(group C)]. Reoperation was performed in patients 8 group A, 4 group B, and 1 group C, and there is no significant diffrence between groups. Adjacent segmental change was found in all reoperation patients, but showed no correlation with clinical results.
CONCLUSIONS
Posterior lumbar interbody fusion with PEEK cage and pedicle screw fixation in lumbar degenerative disease showed excellent clinical results and fusion rates, regardless of patient fusion levels.

Keyword

Lumbar degenerative disease; Posterior lumbar interbody fusion; Pedicle screw; PEEK cage

MeSH Terms

Animals
Follow-Up Studies
Humans
Ketones
Lordosis
Polyethylene Glycols
Reoperation
Retrospective Studies
Ketones
Polyethylene Glycols

Figure

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  Fig. 1. A 69-year-old female presented with back pain, sciatica and neurogenic claudication.(A) Plain lateral radiograph shows degenerative changes on L4-5 lumbar disc space.(B) T2-weighted MRI(sagittal, axial view) shows that dural sac was compressed by extruded disc material and hypertrophied ligamentum flavum on L4-5. (C) Postoperative radiograph shows posterior lumbar interbody fusion with PEEK cage and pedicle screw fixation on L4-5. (D) 3 years after surgery, radiograph shows solid fusion mass on L4-5.

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  Fig. 2. A 61-year-old female presented with back pain and sciatica.(A) Plain lateral radiograph shows degenerative changes and isthmic spondylolisthesis on L4-5 lumbar disc space.(B) T2-weighted MRI(sagittal, axial view) shows spinal stenosis and on L3-4 and L4-5. (C) Postoperative radiograph shows posterior lumbar interbody fusion with PEEK cage and pedicle screw fixation on L3-4 and L4-5. (D,E) 2 years after surgery, radiograph shows adjacent segmental degeneration on L1-2 and L2-3.(F) Revision surgery was performed.

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