J Korean Soc Spine Surg.  2009 Dec;16(4):243-250. 10.4184/jkss.2009.16.4.243.

Posterior Lumbar Interbody Fusion Using New Hydroxyapatite Block: Comparison with Metal and PEEK Cages

• Chung JY
• Chang BS
• Lee CK
• Lee JH
• Kong CB
• Yeom JS
• Park KW
• Moon HJ

• KMID: 1819805
• DOI: http://doi.org/10.4184/jkss.2009.16.4.243

Abstract

STUDY DESIGN: This is a retrospective study
OBJECTIVES
This study compared the clinical outcomes of posterior lumbar interbody fusion (PLIF) using hydroxyapatite blocks with PLIF using a metal or poly-ether-ether-ketone (PEEK) cage. SUMMARY OF THE LITERATURE REVIEW: There are few reports on the clinical outcomes of PLIF using a hydroxyapatite block for treating lumbar degenerative disease.
MATERIALS AND METHODS
The 27 PLIF cases (62 units, HA block) that were followed up for 1-year were compared with 13 cases using a metal cage and 13 cases using a PEEK cage. Pedicle screw fixation was performed for all the cases. If the local bone is deficient, then an additional bone graft with autogeous iliac bone or bone substitute was used. The visual analog scale(VAS) for low back pain and radiating pain, the Oswestry disability index (ODI), the intervertebral height and the halo sign around the cages and pedicle screws were comparatively analyzed.
RESULTS
The mean VAS score for low back pain before PLIF and using the HA block, the metal cage and the PEEK cage was 7.5, 8.3 and 6.2, respectively, and this was 3.3, 2.9 and 4.8 after PLIF (P<0.05 with using the HA block and the metal cage (Wilcoxon test). The mean VAS score for radiating pain before PLIF was 7.9, 8.3 and 8.5, respectively, and the VAS score was 3.5, 3.1 and 3.9, respectively, after PLIF (P<0.05 for all cases, Wilcoxon test). For the ODI, the means before PLIF were 60.3, 51.2 and 53.8, respectively, and they changed to 30.5, 24.9 and 29.7, respectively, after PLIF (P<0 .05 for all cases, Wilcoxon test). On the X-ray images, there was no halo sign greater than 2 mm near the pedicle screws or greater than 1 mm near the cages and no breakage of the HA block. No additional bone graft was needed for the PLIF using the HA block and local bone. There was no statistically significant differences among the groups (P>0.05, One-way ANOVA).
CONCLUSION
PLIF using a HA block showed improvements, including the back pain, and the ODI was satisfactory and this didn't fall below those ODIs of using metal or PEEK cages. Although a HA block may have higher tendency to break, there was no breakage at the 1-year follow up.

Keyword

Posterior lumbar interbody fusion; Hydroxyapatite block; metal cage; PEEK cage

MeSH Terms

Back Pain
Bone Substitutes
Durapatite
Follow-Up Studies
Ketones
Low Back Pain
Polyethylene Glycols
Retrospective Studies
Transplants
Bone Substitutes
Durapatite
Ketones
Polyethylene Glycols

Figure

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  Fig. 1. Close-up photograph and schematic design showing HA block(Bongros<-HA, Bioalpha<).

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  Fig. 2. The sequential standing lateral radiographs of sixty-six-year-old female patient suffering from spinal stenosis with spondylolisthesis L4 on L5. She was treated with PLIF using local bone grafts and HA blocks. (A) The preoperative lateral radiograph showed a anterior transposition of L4 on L5 vertebral body. (B) The immediately postoperative lateral radiograph shows HA blocks with autogenous local bone graft and pedicle screw stabilization on L4-5. (C) The postoperative lateral radiograph (6 months later) shows bony bridging shadow between L4 and L5 vertebral body and the better visualization of grafted local bone surround HA blocks than initial image. (D) The postoperative lateral radiograph (12 months later) shows a better trabecular bony fusion between L4 and L5 vertebral body and well-maintained HA blocks.

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