Posterior Lumbar Interbody Fusion Using a Unilateral Single Cage and a Local Morselized Bone Graft in the Degenerative Lumbar Spine

Background We retrospectively evaluated the clinical and radiological outcomes of posterior lumbar interbody fusion (PLIF) with using a unilateral single cage and a local morselized bone graft. Methods Fifty three patients who underwent PLIF with a unilateral single cage filled with local morselized bone graft were enrolled in this study. The average follow-up duration was 31.1 months. The clinical outcomes were evaluated with using the visual analogue scale (VAS) at the pre-operative period, at 1 year post-operation and at the last follow-up, the Oswestry Disability Index, the Prolo scale and the Kim & Kim criteria at the last follow-up; the radiological outcomes were evaluated according to the change of bone bridging, the radiolucency, the instablity and the disc height. Results For the clinical evaluation, the VAS pain index, the Oswestry Disability Index, the Prolo scale and the Kim & Kim criteria showed excellent outcomes. For the the radiological evaluation, 52 cases showed complete bone union at the last follow-up. Regarding the complications, only 1 patient had cage breakage during follow-up. Conclusions PLIF using a unilateral single cage filled with a local morselized bone graft has the advantages of a shorter operation time, less blood loss and a shorter hospital stay, as compared with the PLIF using bilateral cages, for treating degenerative lumbar spine disease. This technique also provides excellent outcomes according to the clinical and radiological evaluation.

[1]  A. Neidre,et al.  Outcomes of L1-L2 posterior lumbar interbody fusion with the Lumbar I/F cage and the variable screw placement system: reporting unexpected poor fusion results at L1-L2. , 2006, The spine journal : official journal of the North American Spine Society.

[2]  A. Neidre,et al.  Is One Cage Enough in Posterior Lumbar Interbody Fusion: A Comparison of Unilateral Single Cage Interbody Fusion to Bilateral Cages , 2007, Journal of spinal disorders & techniques.

[3]  Huilin Yang,et al.  Cage Migration in Spondylolisthesis Treated With Posterior Lumbar Interbody Fusion Using BAK Cages , 2005, Spine.

[4]  H. Briggs,et al.  CHIP FUSION OF THE LOW BACK FOLLOWING EXPLORATION OF THE SPINAL CANAL , 1944 .

[5]  R. B. Cloward.  The treatment of ruptured lumbar intervertebral discs by vertebral body fusion. I. Indications, operative technique, after care. , 1953, Journal of neurosurgery.

[6]  Cheng-Kung Cheng,et al.  Biomechanical Comparison of Instrumented Posterior Lumbar Interbody Fusion With One or Two Cages by Finite Element Analysis , 2006, Spine.

[7]  G. Bagby.  Arthrodesis by the distraction-compression method using a stainless steel implant. , 1988, Orthopedics.

[8]  D. C. Henckel,et al.  Case report. , 1995, Journal.

[9]  Frederic L. Johnstone,et al.  Are 2 cages needed with instrumented PLIF? A comparison of 1 versus 2 interbody cages in a military population. , 2003, American journal of orthopedics.

[10]  N. Ordway,et al.  Posterior lumbar interbody fusion using posterolateral placement of a single cylindrical threaded cage. , 2000 .

[11]  Jie Zhao,et al.  Posterior lumbar interbody fusion using one diagonal fusion cage with transpedicular screw/rod fixation , 2003, European Spine Journal.

[12]  S. Imagama,et al.  Is Local Bone Viable as a Source of Bone Graft in Posterior Lumbar Interbody Fusion? , 2003, Spine.

[13]  Kuo-Feng Huang,et al.  Clinical results of a single central interbody fusion cage and transpedicle screws fixation for recurrent herniated lumbar disc and low-grade spondylolisthesis. , 2003, Chang Gung medical journal.

[14]  S. Yi,et al.  Posterior Lumbar Interbody Fusion via a Unilateral Approach , 2006, Yonsei medical journal.

[15]  B. Weiner,et al.  Lumbar Interbody Cages , 1998, Spine.

[16]  T. Lund,et al.  Biomechanics of stand-alone cages and cages in combination with posterior fixation: a literature review , 2000, European Spine Journal.

[17]  P M Lin,et al.  Posterior lumbar interbody fusion technique: complications and pitfalls. , 1985, Clinical orthopaedics and related research.

[18]  Y. Ohkoshi,et al.  Clinical Results of Single-Level Posterior Lumbar Interbody Fusion Using the Brantigan I/F Carbon Cage Filled With a Mixture of Local Morselized Bone and Bioactive Ceramic Granules , 2002, Spine.

[19]  N. Kim,et al.  Anterior interbody fusion for spondylolisthesis. , 1991, Orthopedics.

[20]  K. Herrlin,et al.  Posterolateral lumbar fusion. Outcome of 71 consecutive operations after 4 (2-7) years. , 1994, Acta orthopaedica Scandinavica.

[21]  Huilin Yang,et al.  Complications associated with posterior lumbar interbody fusion using Bagby and Kuslich method for treatment of spondylolisthesis. , 2003, Chinese medical journal.

[22]  A. Tencer,et al.  Biomechanical Properties of Threaded Inserts for Lumbar Interbody Spinal Fusion , 1995, Spine.

[23]  R. Molinari,et al.  Epidural Abscess and Discitis Complicating Instrumented Posterior Lumbar Interbody Fusion: A Case Report , 2004, Spine.

[24]  J. Torner,et al.  Spinal stability with anterior or posterior ray threaded fusion cages. , 2000, Journal of neurosurgery.

[25]  L. Perlick,et al.  Radiographic Spinal Profile Changes Induced by Cage Design After Posterior Lumbar Interbody Fusion: Preliminary Report of a Study With Wedged Implants , 2001, Spine.

[26]  A. Neidre,et al.  Achievement of normal sagittal plane alignment using a wedged carbon fiber reinforced polymer fusion cage in treatment of spondylolisthesis. , 2003, The spine journal : official journal of the North American Spine Society.