Article
Circumferential arthrodesis using PEEK cages in degenerative lumbar pathology
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Published: | May 4, 2005 |
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Outline
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Objective
Polyetheretherketone (PEEK) has a low elasticity modulus, that reduces stress shielding, when used as interbody cage. It has been shown to favorize fusion and reduce subsidence rate in the short-term. The goal of this paper was to analyze the results of ALIF procedure using PEEK cages (Stryker) and cancellous bone autograft in addition to two-level pedicle screw posterior instrumentation (Domino, Stryker) in the longer term.
Methods
57 patients aged 54.6 (29 – 75) were reviewed. Six patients were overweighted. The level of arthrodesis was L2L3 in 6 cases, L3L4 in 9 cases, L4L5 in 31 cases, L5S1 in 11 cases. Cage height was 9 to 16 mm. Posterior instrmentation was rigid in 24 cases, and semi-rigid in 33 cases. Intersomatic bone graft represented 59.6% (20 – 95) of the vertebral plateau. While 47 patients had no change in lordosis after surgery, lordosis decreased of 8.2° (5 – 12) in ten cases. Lordosis decrease at follow-up was tested against age, obesity, level, bone graft amount, posterior instrumentation rigidity, post-op lordosis increase, and cage height.
Results
Average follow-up was 5.72 years (4 – 8). Clinical outcomes were excellent in 24 cases, good in 25 cases, fair in 6 cases and poor in 2 cases. Fusion was definite in 56 cases, and probable in one case. Lordosis decreased in 13 cases, of 5.6° (4 – 8). Multivariate analysis was significant (p<0.001; R2=0.590). Lost of correction was signifcantly related with post-op lordosis increase (p=0.01), rigid posterior instrumentation (p=0.026), age (p=0.047), level (p=0.013), and cage size (p<0.001).
Conclusions
Lumbar circumferential arthrodesis using PEEK cages provided good clinical results and fusion rate. However lordosis correction was not maintained in the long-term, specially at lower level, using big cages, in older patients, and when associated with rigid primary posterior instrumentation.