Lumbar interbody cages: Fusing means or only spacers?
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Published:
Jun 6, 2013
Keywords:
Interbody cages, Transforaminal lumbar interbody fusion, Computed tomography
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Abstract
BackgroundSurgical fusion of the lumbar spine is a frequently used method for the treatment of painful lumbar segmental instability; currently the two instrumented fusion techniques most commonly used are posterolateral fusion with pedicle screws, and circumferential fusion by association of interbody cages. Although evidence shows that the association of intersomatic devices increases the fusion rate, most studies do not discriminate if this fusion occurs only posterolaterally, or an anterior fusion also occurs. The aim of this study is to determine if there is a true bone fusion at the level of interbody cages or if they act only as spacers.MethodsWe analyzed 28 patients with lumbar spine pathology surgically treated with one level circumferential lumbar fusion from May 2007 to January 2012, using post-surgical computed tomography, to assess the presence or absence of anterior arthrodesis. A therapeutic value, descriptive, observational study was conducted (evidence level IV); by statistical evaluation, frequency analysis was performed to describe the proportion of cases with anterior fusion.ResultsThe fusion rate reached 92.86%; while there was no anterior radiological fusion in 7.14% of patients. Conclusions: There is a high rate of anterior fusion at the level of the interbody cages, thus demonstrating that these devices act as fusing means and not only as anterior spacers.ConclusionsThere is a high rate of anterior fusion at the level of the interbody cages, thus demonstrating that these devices act as fusing means and not only as anterior spacers.
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Flores Kanter, D. N., Jabif, A. J., & Ortiz, P. N. (2013). Lumbar interbody cages: Fusing means or only spacers?. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 78(2), 74-79. https://doi.org/10.15417/211
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Clinical Research
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References
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2. Madan SS, Harley JM, Boeree NR. Circumferential and posterolateral fusion for lumbar disc disease. Clin Orthop Relat Res 2003;409:114-23.
3. Helenius I, Lamberg T, Osterman K, Schlenzka D, Yrjönen T, Tervahartiala P, et al. Posterolateral, anterior, or circumferential fusion in situ for high-grade spondylolisthesis in young patients: a long-term evaluation using the Scoliosis Research Society Questionnaire. Spine 2006;31:190-6.
4. Tay BB, Berven S. Indications, techniques, and complications of lumbar interbody fusion. Semin Neurol 2002;22(2):221-30.
5. Wang JC, Mummaneni PV, Haid RW. Current treatment strategies for the painful lumbar motion segment posterolateral fusion versus interbody fusion. Spine 2005;30:S33-S43.
6. Ghogawala Z, Benzel EC, Amin-Hanjani S, Barker FG 2nd, Harrington JF, Magge SN, et al. Prospective outcome evaluation after decompression with or without instrumented fusion for lumbar stenosis and degenerative Grade I spondylolisthesis. J Neurosurg (Spine) 2004;1:267-72.
7. Bridwell KH, Sedgewick TA, O’Brien MF, Lenke LG, Baldus C. The role of fusion and instrumentation in the treatment of degenerative spondylolisthesis with spinal stenosis. J Spinal Disord 1993;6:461-72.
8. Fischgrund JS, Mackay M, Herkowitz HN, Brower R, Montgomery DM, Kurz LT. 1997 Volvo Award winner in clinical studies. Degenerative lumbar spondylolisthesis with spinal stenosis: a prospective, randomized study comparing decompressive laminectomy and arthrodesis with and without spinal instrumentation. Spine 1997;22:2807-12.
9. Moller H, Hedlund R. Instrumented and noninstrumented posterolateral fusion in adult spondylolisthesis: a prospective randomized study: part 2. Spine 2000;25:1716-21.
10. Thomsen K, Christensen FB, Eiskjaer SP, Hansen ES, Fruensgaard S, Bünger CE. 1997 Volvo Award winner in clinical studies. The effect of pedicle screw instrumentation on functional outcome and fusion rates in posterolateral fusion: a prospective randomized clinical study. Spine 1997;22:2813-22.
11. Stonecipher T, Wright S. Posterior lumbar interbody fusion with facet-screw fixation. Spine 1989;14:468-71.
12. Mummaneni PV, Haid RW, Rodts GE. Lumbar interbody fusion: state-of the-art technical advances. J Neurosurg (Spine) 2004;1:24-30.
13. Chen WJ, Lai PL, Niu CC, Chen LH, Fu TS, Wong CB. Surgical treatment of adjacent instability after lumbar spine fusion. Spine 2001;26:E519-E524.
14. Matsumura A, Taneichi H, Suda K, Kajino T, Moridaira H, Kaneda K. Comparative study of radiographic disc height changes using two different interbody devices for transforaminal lumbar interbody fusion open box vs. fenestrated tube interbody cage. Spine 2006;31:E871-E876.
15. Tullberg T, Brandt B, Rydberg J, Fritzell P. Fusion rate after posterior lumbar interbody fusion with carbon fiber implant: 1-year follow-up of 51 patients. Eur Spine J 1996;5:178-82.
16. Hee HT, Castro FP Jr, Majd ME, Holt RT, Myers L. Anterior/posterior lumbar fusion versus transforaminal lumbar interbody fusion: analysis of complications and predictive factors. J Spinal Disord 2001;14:533-40.
17. Kozak JA, O’Brien JP. Simultaneous combined anterior and posterior fusion: an independent analysis of a treatment for the disabled low back pain patient. Spine 1990;15:322-8.
18. Aoki Y, Yamagata M, Nakajima F, Ikeda Y, Takahashi K. Posterior migration of fusion cages in degenerative lumbar disease treated with transforaminal lumbar interbody fusion. A report of three patients. Spine 2008;34:E54-E58.
19. Taneichi H, Suda K, Kajino T, Matsumura A, Moridaira H, Kaneda K. Unilateral transforaminal lumbar interbody fusion and bilateral anterior-column fixation with two Brantigan I/F cages per level: clinical outcomes during a minimum 2-year follow-up period. J Neurosurg Spine 2006;4:198-205.
20. Humphreys SC, Hodges SD, Patwardhan AG, Eck JC, Murphy RB, Covington LA. Comparison of posterior and transforaminal approaches to lumbar interbody fusion. Spine 2001;26:567-71.
21. Hacker RJ. Comparison of interbody fusion approaches for disabling low back pain. Spine 1997;22:660-6.
22. Loguidice VA, Johnson RG, Guyer RD, Stith WJ, Ohnmeiss DD, Hochschuler SH, et al. Anterior lumbar interbody fusion. Spine 1988;13:366-9.
23. Coe JD. Instrumented transforaminal lumbar interbody fusion with bioabsorbable polymer implants and iliac crest autograft. Neurosurg Focus 2004;16:1-9.
24. Kwon BK, Berta S, Daffner SD, Vaccaro AR, Hilibrand AS, Grauer JN, et al. Radiographic analysis of transforaminal lumbar interbody fusion for the treatment of adult isthmic spondylolisthesis. J Spinal Disord Tech 2003;16:469-76.
25. Rosenberg WS, Mummaneni PV. Transforaminal lumbar interbody fusion: technique, complications, and early results. Neurosurgery 2001;48:569-75.
26. Baby GW. Arthrodesis by the distraction-compression method using a stainless steel implant. Orthopaedics 1988;11:931-4.
27. Brantigan JW, Steffee AD, Geiger JM. A carbon fiber implant to aid interbody lumbar fusion: mechanical testing. Spine 1991;16:277-82.
28. Lin PM. Posterior lumbar interbody fusion technique: Complications and pitfalls. Clin Orthop 1985;193:16-19.
29. Brodke DS, Dick JC, Kunz DN, McCabe R, Zdeblick TA. Posterior lumbar interbody fusion: a biomechanical comparison, including a new threaded cage. Spine 1997;22(1):26-31.
30. Christensen FB, Bunger CE. Retrograde ejaculation after retroperitoneal lower lumbar interbody fusion. Int Orthop 1997;21:176-80.
31. Isiklar ZU, Lindsey RW, Coburn M. Ureteral injury after anterior lumbar interbody fusion: A case report. Spine 1996;21:2379-82.
32. Ames CP, Acosta FL Jr, Chi J, Iyengar J, Muiru W, Acaroglu E, et al. Biomechanical comparison of posterior lumbar interbody fusion and transforaminal lumbar interbody fusion performed at 1 and 2 levels. Spine 2005;30:E562-E566.
33. Brantigan JW, Neidro A, Toohey JS. The lumbar I/F cage for posterior lumbar interbody fusion with the variable screw placement system: 10-year results of a Food and Drug Administration clinical trial. Spine J 2004;4:681-8.
34. La Rosa G, Conti A, Cacciola F, Cardali S, La Torre D, Gambadauro NM, et al. Pedicle screw fixation for isthmic spondylolisthesis: does posterior lumbar interbody fusion improve outcome over posterolateral fusion? J Neurosurg (Spine 2) 2003;99:143-50.
35. Enker P, Steffee AD. Interbody fusion and instrumentation. Clin Orthop 1994;300:90-101.
36. Lowe TG, Tahernia AD, O’Brien MF, Smith DA. Unilateral transforaminal posterior lumbar interbody fusion (TLIF): indications,
technique, and 2-year results. J Spinal Disord Tech 2002;15:31-8.
37. Madan S, Boeree NR. Outcome of posterior lumbar interbody fusion versus posterolateral fusion for spondylolytic spondylolisthesis. Spine 2002;27:1536-42.
38. Salehi SA, Tawk R, Ganju A, LaMarca F, Liu JC, Ondra SL. Transforaminal lumbar interbody fusion technique and results in 24 patients. Neurosurgery 2004;54:368-74.
39. Lauber S, Schulte TL, Liljenqvist U, Halm H, Hackenberg L. Clinical and radiologic 2-4-year results of transforaminal lumbar interbody fusion in degenerative and isthmic spondylolisthesis grades 1 and 2. Spine 2006;31:1693-8.
40. Zdeblick TA, Phillips FM. Interbody cage devices. Spine 2003;28:S2-S7.
2. Madan SS, Harley JM, Boeree NR. Circumferential and posterolateral fusion for lumbar disc disease. Clin Orthop Relat Res 2003;409:114-23.
3. Helenius I, Lamberg T, Osterman K, Schlenzka D, Yrjönen T, Tervahartiala P, et al. Posterolateral, anterior, or circumferential fusion in situ for high-grade spondylolisthesis in young patients: a long-term evaluation using the Scoliosis Research Society Questionnaire. Spine 2006;31:190-6.
4. Tay BB, Berven S. Indications, techniques, and complications of lumbar interbody fusion. Semin Neurol 2002;22(2):221-30.
5. Wang JC, Mummaneni PV, Haid RW. Current treatment strategies for the painful lumbar motion segment posterolateral fusion versus interbody fusion. Spine 2005;30:S33-S43.
6. Ghogawala Z, Benzel EC, Amin-Hanjani S, Barker FG 2nd, Harrington JF, Magge SN, et al. Prospective outcome evaluation after decompression with or without instrumented fusion for lumbar stenosis and degenerative Grade I spondylolisthesis. J Neurosurg (Spine) 2004;1:267-72.
7. Bridwell KH, Sedgewick TA, O’Brien MF, Lenke LG, Baldus C. The role of fusion and instrumentation in the treatment of degenerative spondylolisthesis with spinal stenosis. J Spinal Disord 1993;6:461-72.
8. Fischgrund JS, Mackay M, Herkowitz HN, Brower R, Montgomery DM, Kurz LT. 1997 Volvo Award winner in clinical studies. Degenerative lumbar spondylolisthesis with spinal stenosis: a prospective, randomized study comparing decompressive laminectomy and arthrodesis with and without spinal instrumentation. Spine 1997;22:2807-12.
9. Moller H, Hedlund R. Instrumented and noninstrumented posterolateral fusion in adult spondylolisthesis: a prospective randomized study: part 2. Spine 2000;25:1716-21.
10. Thomsen K, Christensen FB, Eiskjaer SP, Hansen ES, Fruensgaard S, Bünger CE. 1997 Volvo Award winner in clinical studies. The effect of pedicle screw instrumentation on functional outcome and fusion rates in posterolateral fusion: a prospective randomized clinical study. Spine 1997;22:2813-22.
11. Stonecipher T, Wright S. Posterior lumbar interbody fusion with facet-screw fixation. Spine 1989;14:468-71.
12. Mummaneni PV, Haid RW, Rodts GE. Lumbar interbody fusion: state-of the-art technical advances. J Neurosurg (Spine) 2004;1:24-30.
13. Chen WJ, Lai PL, Niu CC, Chen LH, Fu TS, Wong CB. Surgical treatment of adjacent instability after lumbar spine fusion. Spine 2001;26:E519-E524.
14. Matsumura A, Taneichi H, Suda K, Kajino T, Moridaira H, Kaneda K. Comparative study of radiographic disc height changes using two different interbody devices for transforaminal lumbar interbody fusion open box vs. fenestrated tube interbody cage. Spine 2006;31:E871-E876.
15. Tullberg T, Brandt B, Rydberg J, Fritzell P. Fusion rate after posterior lumbar interbody fusion with carbon fiber implant: 1-year follow-up of 51 patients. Eur Spine J 1996;5:178-82.
16. Hee HT, Castro FP Jr, Majd ME, Holt RT, Myers L. Anterior/posterior lumbar fusion versus transforaminal lumbar interbody fusion: analysis of complications and predictive factors. J Spinal Disord 2001;14:533-40.
17. Kozak JA, O’Brien JP. Simultaneous combined anterior and posterior fusion: an independent analysis of a treatment for the disabled low back pain patient. Spine 1990;15:322-8.
18. Aoki Y, Yamagata M, Nakajima F, Ikeda Y, Takahashi K. Posterior migration of fusion cages in degenerative lumbar disease treated with transforaminal lumbar interbody fusion. A report of three patients. Spine 2008;34:E54-E58.
19. Taneichi H, Suda K, Kajino T, Matsumura A, Moridaira H, Kaneda K. Unilateral transforaminal lumbar interbody fusion and bilateral anterior-column fixation with two Brantigan I/F cages per level: clinical outcomes during a minimum 2-year follow-up period. J Neurosurg Spine 2006;4:198-205.
20. Humphreys SC, Hodges SD, Patwardhan AG, Eck JC, Murphy RB, Covington LA. Comparison of posterior and transforaminal approaches to lumbar interbody fusion. Spine 2001;26:567-71.
21. Hacker RJ. Comparison of interbody fusion approaches for disabling low back pain. Spine 1997;22:660-6.
22. Loguidice VA, Johnson RG, Guyer RD, Stith WJ, Ohnmeiss DD, Hochschuler SH, et al. Anterior lumbar interbody fusion. Spine 1988;13:366-9.
23. Coe JD. Instrumented transforaminal lumbar interbody fusion with bioabsorbable polymer implants and iliac crest autograft. Neurosurg Focus 2004;16:1-9.
24. Kwon BK, Berta S, Daffner SD, Vaccaro AR, Hilibrand AS, Grauer JN, et al. Radiographic analysis of transforaminal lumbar interbody fusion for the treatment of adult isthmic spondylolisthesis. J Spinal Disord Tech 2003;16:469-76.
25. Rosenberg WS, Mummaneni PV. Transforaminal lumbar interbody fusion: technique, complications, and early results. Neurosurgery 2001;48:569-75.
26. Baby GW. Arthrodesis by the distraction-compression method using a stainless steel implant. Orthopaedics 1988;11:931-4.
27. Brantigan JW, Steffee AD, Geiger JM. A carbon fiber implant to aid interbody lumbar fusion: mechanical testing. Spine 1991;16:277-82.
28. Lin PM. Posterior lumbar interbody fusion technique: Complications and pitfalls. Clin Orthop 1985;193:16-19.
29. Brodke DS, Dick JC, Kunz DN, McCabe R, Zdeblick TA. Posterior lumbar interbody fusion: a biomechanical comparison, including a new threaded cage. Spine 1997;22(1):26-31.
30. Christensen FB, Bunger CE. Retrograde ejaculation after retroperitoneal lower lumbar interbody fusion. Int Orthop 1997;21:176-80.
31. Isiklar ZU, Lindsey RW, Coburn M. Ureteral injury after anterior lumbar interbody fusion: A case report. Spine 1996;21:2379-82.
32. Ames CP, Acosta FL Jr, Chi J, Iyengar J, Muiru W, Acaroglu E, et al. Biomechanical comparison of posterior lumbar interbody fusion and transforaminal lumbar interbody fusion performed at 1 and 2 levels. Spine 2005;30:E562-E566.
33. Brantigan JW, Neidro A, Toohey JS. The lumbar I/F cage for posterior lumbar interbody fusion with the variable screw placement system: 10-year results of a Food and Drug Administration clinical trial. Spine J 2004;4:681-8.
34. La Rosa G, Conti A, Cacciola F, Cardali S, La Torre D, Gambadauro NM, et al. Pedicle screw fixation for isthmic spondylolisthesis: does posterior lumbar interbody fusion improve outcome over posterolateral fusion? J Neurosurg (Spine 2) 2003;99:143-50.
35. Enker P, Steffee AD. Interbody fusion and instrumentation. Clin Orthop 1994;300:90-101.
36. Lowe TG, Tahernia AD, O’Brien MF, Smith DA. Unilateral transforaminal posterior lumbar interbody fusion (TLIF): indications,
technique, and 2-year results. J Spinal Disord Tech 2002;15:31-8.
37. Madan S, Boeree NR. Outcome of posterior lumbar interbody fusion versus posterolateral fusion for spondylolytic spondylolisthesis. Spine 2002;27:1536-42.
38. Salehi SA, Tawk R, Ganju A, LaMarca F, Liu JC, Ondra SL. Transforaminal lumbar interbody fusion technique and results in 24 patients. Neurosurgery 2004;54:368-74.
39. Lauber S, Schulte TL, Liljenqvist U, Halm H, Hackenberg L. Clinical and radiologic 2-4-year results of transforaminal lumbar interbody fusion in degenerative and isthmic spondylolisthesis grades 1 and 2. Spine 2006;31:1693-8.
40. Zdeblick TA, Phillips FM. Interbody cage devices. Spine 2003;28:S2-S7.