Skip to main content

Advertisement

SpringerLink
Log in

Comparing the early efficacies of autologous bone grafting and interbody fusion cages for treating degenerative lumbar instability in patients of different ages

  • Original Paper
  • Published:
International Orthopaedics Aims and scope Submit manuscript

Abstract

Purpose

The aim of this study was to compare the early efficacies of interbody fusion using autologous bone graft or an interbody fusion cage in a modified transforaminal lumbar interbody fusion (TLIF) in patients of different ages with degenerative lumbar instability.

Methods

Data from 33 patients with double-segment degenerative lumbar instability treated with a modified TLIF combined with a posterior fixation system from December 2008 to June 2014 were retrospectively analyzed. The two segments separately received an interbody bone graft fusion and an interbody fusion cage. Patients were divided by age into group A (middle-aged and elderly group, age ≥ 55 years, n = 13) and group B (young adult group, age < 55 years, n = 20). The clinical efficacy of the modified TLIF combined with a posterior fixation system was assessed using the Japanese Orthopaedic Association (JOA), Oswestry Disability Index (ODI), and Visual Analogue Scale (VAS) scores obtained before and after surgery, and at final follow-up. We measured the mean intervertebral space height, intervertebral foramen height, lumbar lordosis angle, and inter-technique differences in the mean intervertebral space height and intervertebral foramen height. Interbody fusion was evaluated using the Suk standard.

Results

Patients in group A followed-up for 19.15 ± 8.01 months. Patients in group B followed-up for 14.80 ± 5.47 months. The post-operative JOA, ODI, VAS, and lumbar lordosis angle were improved significantly. Moreover, the early clinical follow-up effect was good. In group A, significant differences in the intervertebral foramen height post-surgery and at final follow-up, and the mean intervertebral space height at final follow-up were noted. The intervertebral foramen and space heights were increased in the interbody cage group. In group B, a significant difference in the intervertebral foramen height at final follow-up was noted. The mean intervertebral space height post-surgery and at final follow-up was significantly increased between the two fusion methods. Bony fusion was achieved in all cases. The fusion time of autologous bone graft and interbody fusion cage was 5.46 ± 1.20 months and 6.77 ± 1.01 months respectively in group A, and 5.50 ± 1.28 months and 6.35 ± 1.76 months respectively in group B, the difference in fusion time between techniques was significant.

Conclusion

At different ages, the interbody fusion cages can better preserve the intervertebral space and the intervertebral foramen height. However, autologous bone graft can rapidly achieve a bony fusion. Interbody fusion cages are therefore ideal for young adults, while autologous bone grafting is ideal for middle-aged and elderly patients who receive a modified TLIF.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Arnold PM, Robbins S, Paullus W, Faust S, Holt R, McGuire R (2009) Clinical outcomes of lumbar degenerative disc disease treated with posterior lumbar interbody fusion allograft spacer: a prospective, multicenter trial with 2-year follow-up. Am J Orthop (Belle Mead NJ) 38:E115–E122

    Google Scholar 

  2. Herkowitz HN, Sidhu KS (1995) Lumbar spine fusion in the treatment of degenerative conditions: current indications and recommendations. J Am Acad Orthop Surg 3:123–135

    Article  PubMed  Google Scholar 

  3. Burkus JK, Schuler TC, Gornet MF, Zdeblick TA (2004) Anterior lumbar interbody fusion for the management of chronic lower back pain: current strategies and concepts. Orthop Clin North Am 35:25–32

    Article  PubMed  Google Scholar 

  4. Kaiser MG, Haid RW Jr, Subach BR, Miller JS, Smith CD, Rodts GE Jr (2002) Comparison of the mini-open versus laparoscopic approach for anterior lumbar interbody fusion: a retrospective review. Neurosurgery 51:97–103

    Article  PubMed  Google Scholar 

  5. Cloward RB (1953) The treatment of ruptured lumbar intervertebral discs by vertebral body fusion. I. indications, operative technique, after care. J Neurosurg 10:154–168

    Article  CAS  PubMed  Google Scholar 

  6. Fujimori T, Le H, Schairer WW, Berven SH, Qamirani E, Hu SS (2015) Does transforaminal lumbar interbody fusion have advantages over posterolateral lumbar fusion for degenerative spondylolisthesis? Global Spine J 5:102–109

    PubMed  Google Scholar 

  7. DiPaola CP, Molinari RW (2008) Posterior lumbar interbody fusion. J Am Acad Orthop Surg 16:130–139

    Article  PubMed  Google Scholar 

  8. Mehta VA, McGirt MJ, Garcés Ambrossi GL, Parker SL, Sciubba DM, Bydon A, Wolinsky JP, Gokaslan ZL, Witham TF (2011) Trans-foraminal versus posterior lumbar interbody fusion: comparison of surgical morbidity. Neurol Res 33:38–42

    Article  PubMed  Google Scholar 

  9. Stonecipher T, Wright S (1989) Posterior lumbar interbody fusion with facet-screw fixation. Spine (Phila Pa 1976) 14(4):468–471

    Article  CAS  Google Scholar 

  10. Harms J, Rolinger H (1982) A one-stager procedure in operative treatment of spondylolistheses: dorsal traction-reposition and anterior fusion (author’s transl). Z Orthop Ihre Grenzgeb 120:343–347

    Article  CAS  PubMed  Google Scholar 

  11. Cole CD, McCall TD, Schmidt MH, Dailey AT (2009) Comparison of low back fusion techniques: transforaminal lumbar interbody fusion (TLIF) or posterior lumbar interbody fusion (PLIF) approaches. Curr Rev Musculoskelet Med 2:118–126

    Article  PubMed  PubMed Central  Google Scholar 

  12. Lv FZ, Wang HL, Jiang JY, Ma X, Xia XL, Wang LX (2011) Mast Quadrant-assisted modified transforaminal lumbar interbody fusion. Chin J Orthopaed 31:1072–1077

    Google Scholar 

  13. Abdul QR, Qayum MS, Saradhi MV, Panigrahi MK, Sreedhar V (2011) Clinico-radiological profile of indirect neural decompression using cage or auto graft as interbody construct in posterior lumbar interbody fusion in spondylolisthesis: Which is better? J Craniovertebr Junct Spine 2:12–16

    Article  CAS  Google Scholar 

  14. Zhang NN, Hao YH (2013) The investigation of bone mineral density on 1096 cases Han population in Daqing area and their incidence of osteoporosis. Chin J Osteop 19:1095–1098

    Google Scholar 

  15. Li CH, Ye W, Li JY, Huang DS, Liu SL, Zhang SL (2008) The effects of posterior fusion cage on stabilization in different segmental lumbar spine. Chin J Clin Anatomy 26:677–679

    CAS  Google Scholar 

  16. Dennis S, Watkins R, Landaker S, Dillin W, Springer D (1989) Comparison of disc space heights after anterior lumbar interbody fusion. Spine (Phila Pa 1976) 14:876–878

    Article  CAS  Google Scholar 

  17. Liu Z, Liu J, Tan Y, He L, Long X, Yang D, Huang S, Shu Y (2014) A comparative study between local bone graft with a cage and with no cage in single posterior lumbar interbody fusion (PLIF): a multicenter study. Arch Orthop Trauma Surg 134:1051–1057

    Article  PubMed  Google Scholar 

  18. Miura Y, Imagama S, Yoda M, Mitsuguchi H, Kachi H (2003) Is local bone viable as a source of bone graft in posterior lumbar interbody fusion? Spine (Phila Pa 1976) 28(20):2386–2389

    Article  Google Scholar 

  19. Suk SI, Lee CK, Kim WJ, Lee JH, Cho KJ, Kim HG (1997) Adding posterior lumbar interbody fusion to pedicle screw fixation and posterolateral fusion after decompression in spondylolytic spondylolisthesis. Spine (Phila Pa 1976) 22:210–219, discussion 219-220

    Article  CAS  Google Scholar 

  20. Beutler WJ, Peppelman WC Jr (2003) Anterior lumbar fusion with paired BAK standard and paired BAK Proximity cages: subsidence incidence, subsidence factors, and clinical outcome. Spine J 3:289–293

    Article  PubMed  Google Scholar 

  21. Oxland TR, Lund T (2000) Biomechanics of stand-alone cages and cages in combination with posterior fixation: a literature review. Eur Spine J 9(Suppl 1):S95–S101

    Article  PubMed  Google Scholar 

  22. Kotil K, Ali Akçetin M, Savaş Y (2013) Clinical and radiologic outcomes of TLIF applications with or without pedicle screw: a double center prospective pilot comparative study. J Spinal Disord Tech 26:359–366

    Article  PubMed  Google Scholar 

  23. Ames CP, Acosta FL Jr, Chi J, Iyengar J, Muiru W, Acaroglu E, Puttlitz CM (2005) Biomechanical comparison of posterior lumbar interbody fusion and transforaminal lumbar interbody fusion performed at 1 and 2 levels. Spine (Phila Pa 1976) 30:E562–E566

    Article  Google Scholar 

  24. Boden SD, Schimandle JH, Hutton WC (1995) An experimental lumbar intertransverse process spinal fusion model. radiographic, histologic, and biomechanical healing characteristics. Spine (Phila Pa 1976) 20:412–420

    Article  CAS  Google Scholar 

  25. Brodke DS, Dick JC, Kunz DN, McCabe R, Zdeblick TA (1997) Posterior lumbar interbody fusion. a biomechanical comparison, including a new threaded cage. Spine (Phila Pa 1976) 22:26–31

    Article  CAS  Google Scholar 

  26. Wang ST, Goel VK, Fu CY, Kubo S, Choi W, Liu CL, Chen TH (2006) Comparison of two interbody fusion cages for posterior lumbar interbody fusion in a cadaveric model. Int Orthop 30:299–304

    Article  PubMed  PubMed Central  Google Scholar 

  27. Rihn JA, Kirkpatrick K, Albert TJ (2010) Graft options in posterolateral and posterior interbody lumbar fusion. Spine 35(17):1629–1639

    Article  PubMed  Google Scholar 

  28. Cutler AR, Siddiqui S, Mohan AL et al. (2006) Comparison of polyetheretherketone cages with femoral cortical bone allograft as a single-piece interbody spacer in transforaminal lumbar interbody fusion. J Neurosurg Spine 5(6):534–539

    Article  PubMed  Google Scholar 

  29. Zdeblick TA, Phillips FM (2003) Interbody cage devices. Spine 28(15):S2–S7

    PubMed  Google Scholar 

  30. Weiner BK, Fraser RD (1998) Spine update lumbar interbody cages. Spine (Phila Pa 1976) 23:634–640

    Article  CAS  Google Scholar 

  31. Patil SS, Rawall S, Nagad P, Shial B, Pawar U, Nene AM (2011) Outcome of single level instrumented posterior lumbar interbody fusion using corticocancellous laminectomy bone chips. Indian J Orthop 45:500–503

    Article  PubMed  PubMed Central  Google Scholar 

  32. Song D, Chen Z, Song D et al. (2015) Comparison of posterior lumbar interbody fusion (PLIF) with autogenous bone chips and PLIF with cage for treatment of double-level isthmic spondylolisthesis. Clin Neurol Neurosurg 138:111–116

    Article  PubMed  Google Scholar 

  33. Hasegawa K, Abe M, Washio T, Hara T (2001) An experimental study on the interface strength between titanium mesh cage and vertebra in reference to vertebral bone mineral density. Spine 26(8):957–963

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgments

This study was supported by Anhui Provincial Natural Science Foundation (No.1408085MH184).

Author information

Author notes

    Authors and Affiliations

    1. Department of Orthopedics, The Second Hospital of Anhui Medical University, Hefei, 230601, China

      Hua-zhang Zhong, Da-sheng Tian, Yun Zhou, Jue-hua Jing, Jun Qian, Lei Chen & Bin Zhu

    2. Department of Rehabilitation Medicine, The Second Hospital Of Anhui Medical University, Hefei, 230601, China

      Yun Zhou

    Authors
    1. Hua-zhang Zhong
      View author publications

      You can also search for this author in PubMed Google Scholar

    2. Da-sheng Tian
      View author publications

      You can also search for this author in PubMed Google Scholar

    3. Yun Zhou
      View author publications

      You can also search for this author in PubMed Google Scholar

    4. Jue-hua Jing
      View author publications

      You can also search for this author in PubMed Google Scholar

    5. Jun Qian
      View author publications

      You can also search for this author in PubMed Google Scholar

    6. Lei Chen
      View author publications

      You can also search for this author in PubMed Google Scholar

    7. Bin Zhu
      View author publications

      You can also search for this author in PubMed Google Scholar

    Corresponding author

    Correspondence to Yun Zhou.

    Ethics declarations

    Conflict of interest

    None.

    Additional information

    Hua-zhang Zhong and Da-sheng Tian contributed equally to this work.

    Rights and permissions

    Reprints and permissions

    About this article

    Check for updates. Verify currency and authenticity via CrossMark

    Cite this article

    Zhong, Hz., Tian, Ds., Zhou, Y. et al. Comparing the early efficacies of autologous bone grafting and interbody fusion cages for treating degenerative lumbar instability in patients of different ages. International Orthopaedics (SICOT) 40, 1211–1218 (2016). https://doi.org/10.1007/s00264-016-3124-4

    Download citation

    • Received:

    • Accepted:

    • Published:

    • Issue Date:

    • DOI: https://doi.org/10.1007/s00264-016-3124-4

    Keywords

    Search

    Navigation