Autologous bone cage in PLIF offers similar 2-year results to PEEK cage

Study Type: Therapy
OE Level of Evidence: 2
Journal Level of Evidence: N/A
Synopsis
69 patients scheduled for single-level posterior lumbar interbody fusion were randomized to one of two different implant groups: one group received an autologous cage consisting of the resected spinous process and lamina (ACSP) from earlier in the procedure, and one group received a polyetheretherketone (PEEK) cage. The purpose of this study was to determine and compare clinical and radiographical results of the ACSP group in comparison to the PEEK cage group over 24-month follow-up. Results demonstrated no Please login to view the rest of this report. Please login to view the rest of this report.
Funding: Non-funded
Conflicts: None disclosed
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Why was this study needed now?
Posterior lumbar interbody fusion is a standard procedure performed in the treatment of patients with degenerative lumbar disc disease. Synthetic fusion cages made of polyetheretherketone (PEEK) are often used to complete these procedures. While generally accepted as providing patients with excellent outcomes, PEEK cages, as a result of their synthetic nature, can result in long-term complications and need for removal. An autologous graft composed from en bloc resection of the spinous process and laminae during surgery has been suggested as a possible alternative, although data on the efficacy of this graft material is limited.
What was the principal research question?
In posterior lumbar interbody fusion, is there any significant difference between an autologous cage made from the lumbar spinal process and lamina and a standard, synthetic polyetheretherketone (PEEK) cage in clinical and radiological results over 24-month follow-up?
Population: 69 patients, between 30 and 70 years of age, scheduled for posterior lumbar interbody fusion due to symptomatic single-level degenerative lumbar disease for at least 6 months. All cases were performed under general anesthesia, with procedures standardized except for the randomized implant material. Following exposure of the spinous process and lamina, en bloc resection was performed. Decompression and discectomy were then performed, followed by measurement for implant sizing.
Intervention: ACSP group: The implant was made up from the resected spinous process and lamina harvested previously during the procedure. The spinous process was trimmed appropriate to the size of implant needed (bone block), while the lamina was cut into small pieces to allow for impacting of the main bone block. Lastly, interpedicular screws were inserted and connected via rods. (n=34)
Comparison: PEEK group: Following discectomy, a polyetheretherketone (PEEK) cage was inserted into the intervertebral space, with interpedicular screws and rods used as in the ACSP group. (n=35)
Outcomes: Clinical assessment was made through a visual analog scale (VAS) for pain, as well as the Kirkaldy-Willis criteria, which grades patients as either Excellent, Good, Fair, or Poor based on the ability to return to work and activities of daily living. Anteroposterior and lateral flexion-extension radiographs were used to assess fusion status. Computed tomography (CT) was used to assess disk height and regional lordosis (ie. angle of the upper and lower edges of the operated intervertebral disc).
Methods: RCT; Assessor-blind, Single-surgeon
Time: Follow-up scheduled for 3, 6, 12, and 24 months after surgery.
What were the important findings?
What should I remember most?
How will this affect the care of my patients?
The authors responsible for this critical appraisal and ACE Report indicate no potential conflicts of interest relating to the content in the original publication.