Surgical outcomes after posterior lumbar interbody fusion using traditional trajectory screw fixation or cortical bone trajectory screw fixation: A comparative study between the polyetheretherketone cage and the same shape titanium-coated polyetheretherketone cage,Clinical Neurology and Neurosurgery

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Surgical outcomes after posterior lumbar interbody fusion using traditional trajectory screw fixation or cortical bone trajectory screw fixation: A comparative study between the polyetheretherketone cage and the same shape titanium-coated polyetheretherketone cage
Clinical Neurology and Neurosurgery ( IF 1.9 ) Pub Date : 2021-09-17 , DOI: 10.1016/j.clineuro.2021.106945
Hironobu Sakaura ₁ , Daisuke Ikegami ₁ , Takahito Fujimori ₂ , Tsuyoshi Sugiura ₁ , Shutaro Yamada ₁ , Yoshihiro Mukai ₃

Affiliation

Objective

To investigate whether or not the fusion rate after posterior lumbar interbody fusion with cortical bone trajectory screw fixation (CBT-PLIF) is lower than after PLIF using traditional trajectory screw fixation (TT-PLIF) and whether or not the titanium-coated polyetheretherketone (PEEK) cage (TiP cage) improves fusion status compared to the same shape uncoated PEEK cage (P cage).

Methods

The subjects were 37 patients undergoing TT-PLIF using P cages (P-TT group), 24 patients undergoing CBT-PLIF using P cages (P-CBT group), 32 patients undergoing TT-PLIF using TiP cages (TiP-TT group), and 20 patients undergoing CBT-PLIF using TiP cages (TiP-CBT group). All patients from the 4 groups underwent our unified PLIF procedure (total facetectomy, subtotal discectomy, and the same bone graft technique using the same shape cages) except for the screw trajectories and the surface materials of the cages. Clinical symptoms were assessed using the Japanese Orthopedic Association (JOA) score before surgery and at 2-year postoperatively. None of age at the time of surgery, gender, fused segment and preoperative JOA score showed significant differences among the 4 groups. On multiplanar reconstruction computed tomography (MPR-CT) at 6months after surgery, vertebral end plate cysts were evaluated and classified into local or diffuse cysts. Fusion status was assessed using both dynamic plain radiographs and MPR-CT at postoperative 2-year.

Results

Neither the mean JOA score nor the mean recovery rate of the JOA score at 2-year after surgery showed significant differences among the 4 groups. The incidence of the diffuse cyst (a known predictor of non-union) was 27.0% in the P-TT group, 29.2% in the P-CBT group, 25.0% in the TiP-TT group and 25.0% in the TiP-CBT group (P > 0.05). The fusion rate was 89.2% in the P-TT group, 91.7% in the P-CBT group, 90.6% in the TiP-TT group and 90.0% in the TiP-CBT group (P > 0.05).

Conclusions

After our unified PLIF procedure except for the screw trajectories and the surface materials of the cages, CBT-PLIF resulted in the equivalent fusion rate to TT-PLIF and the TiP cage did not lead to the improved fusion rate compared to the same shape P cage.

中文翻译：

传统轨迹螺钉固定或皮质骨轨迹螺钉固定后腰椎椎间融合术后的手术效果：聚醚醚酮笼与同形钛涂层聚醚醚酮笼的比较研究

客观的

探讨后路腰椎椎间融合皮质骨轨迹螺钉内固定（CBT-PLIF）的融合率是否低于传统轨迹螺钉内固定（TT-PLIF）以及钛涂层聚醚醚酮（PEEK ) 保持架（TiP 保持架）与相同形状的无涂层 PEEK 保持架（P 保持架）相比改善了融合状态。

方法

受试者为 37 名使用 P 笼进行 TT-PLIF 的患者（P-TT 组），24 名使用 P 笼进行 CBT-PLIF 的患者（P-CBT 组），32 名使用 TiP 笼进行 TT-PLIF 的患者（TiP-TT 组），以及 20 名使用 TiP 笼子接受 CBT-PLIF 的患者（TiP-CBT 组）。4 组的所有患者都接受了我们统一的 PLIF 手术（全小关节切除术、次全椎间盘切除术和使用相同形状的笼子的相同骨移植技术），除了螺钉轨迹和笼子的表面材料。在手术前和术后 2 年使用日本骨科协会 (JOA) 评分评估临床症状。4组手术时年龄、性别、融合节段及术前JOA评分均无显着差异。在术后 6 个月的多平面重建计算机断层扫描 (MPR-CT) 上，评估椎体终板囊肿并将其分为局部或弥漫性囊肿。在术后 2 年使用动态平片和 MPR-CT 评估融合状态。

结果

术后2年JOA平均评分和JOA评分平均恢复率在4组间均无显着差异。P-TT 组弥漫性囊肿（已知的不愈合预测因子）的发生率为 27.0%，P-CBT 组为 29.2%，TiP-TT 组为 25.0%，TiP-CBT 为 25.0%组 ( P > 0.05)。P-TT组融合率为89.2%，P-CBT组为91.7%，TiP-TT组为90.6%，TiP-CBT组为90.0%（P > 0.05）。