J Korean Soc Spine Surg.  2006 Dec;13(4):284-291.

Posterior Lumbar Interbody Fusion Using Titanium Cages and Morselized Local Bone Autograft

• Lee JC
• Cha JS
• Song HY
• Kim YI
• Shin BJ

Abstract

STUDY DESIGN: A retrospective study to evaluate the results of posterior lumbar interbody fusion (PLIF) using titanium cages filled with morselized local bone.
OBJECTIVE
To verify the clinical and radiological results of the PLIF procedure using rectangular titanium cages filled with morselized local bone. SUMMARY AND LITERATURE REVIEW: Stabilization of the spine can be achieved by interbody arthrodesis through the posterior approach. However many significant problems including bone graft collapse, resorption, nonunion, and iliac donor site morbidity caused by the classic PLIF procedure need to be solved. The use of local bone and a titanium cage might be a solution. MATERIALS AND METHOD: Fifty-nine patients(average age at surgery, 51.3 years), who underwent surgery for degenerated low back disease, were enrolled in this study. The average follow-up duration was 19.9 months. The radiological fusion status, intervertebral disc heights, visual analogue scales, clinical outcomes were evaluated.
RESULTS
Forty-three (73%) patients were classified as complete-union, 16 (27%) patients as probable-union, and no patients were classified as non-union. The average intervertebral disc height increased by 3.7 mm at immediate postoperatively, and the average subsidence was 1.1 mm at the final follow-up. The average visual analogue scale decreased from 5.5 to 1.4 for back pain and from 6.6 to 0.8 for radicular pain. Nineteen (32%) and 28 (48%) patients were classified as excellent and good, respectively, according to clinical outcome assessment by Kim and Kim criteria. The complications encountered were a dural tear in 8 patients, partial root injury in 1, and upper adjacent segment instability during follow-up in 2.
CONCLUSION
PLIF using titanium cages filled with morselized local bone has the advantages of maintaining an intervertebral disc height, immediate stability, and the avoidance of donor site morbidity. However, longer-term results are needed, because the follow-up period of this study was relatively short

Keyword

Posterior lumbar interbody fusion; Titanium cage; Morselized local bone; Pedicle screw

MeSH Terms

Arthrodesis
Autografts*
Back Pain
Follow-Up Studies
Humans
Intervertebral Disc
Retrospective Studies
Spine
Tears
Tissue Donors
Titanium*
Transplants
Weights and Measures
Titanium

Figure

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  Fig. 1. Changes of disc height.

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  Fig. 2. A 43-year-old male patient with L4 isthmic spondylolisthesis and bilateral L4 radiculopathy. (A) Preoperative lateral view shows moderate anterior slipping of L4, decrease in disc height at L4-5. (B) Lateral view after surgery shows reduction of the slip, restoration of disc height. (C) At 3 year after surgery, lateral radiograph shows solid fusion and maintainance of reduction.

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