Abstract
In posterior lumbar interbody fusion, cage migrations and lower fusion rates compared to autologous bone graft used in the anterior lumbar interbody fusion procedure are documented. Anatomical and biomechanical data have shown that the cage positioning and cage type seem to play an important role. Therefore, the aim of the present study was to evaluate the impact of cage positioning and cage type on cage migration and fusion. We created a grid system for the endplates to analyze different cage positions. To analyze the influence of the cage type, we compared “closed” box titanium cages with “open” box titanium cages. This study included 40 patients with 80 implanted cages. After pedicle screw fixation, 23 patients were treated with a “closed box” cage and 17 patients with an “open box” cage. The follow-up period averaged 25 months. Twenty cages (25%) showed a migration into one vertebral endplate of <3 mm and four cages (5%) showed a migration of ≥3 mm. Cage migration was highest in the medio-medial position (84.6%), followed by the postero-lateral (42.9%), and the postero-medial (16%) cage position. Closed box cages had a significantly higher migration rate than open box cages, but fusion rates did not differ. In conclusion, cage positioning and cage type influence cage migration. The medio-medial cage position showed the highest migration rate. Regarding the cage type, open box cages seem to be associated with lower migration rates compared to closed box cages. However, the cage type did not influence bone fusion.
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Abbushi A (2007) Klinische und radiologische Ergebnisse nach monosegmentaler “posterior lumbar interbody fusion” (PLIF) mit zwei unterschiedlichen Titancages und dorsaler Stabilisierung bei degenerativer Spondylolisthese. Medizinische Fakultät Charité-Universitätsmedizin Berlin, Berlin, pp 1–69
Agazzi S, Reverdin A, May D (1999) Posterior lumbar interbody fusion with cages: an independent review of 71 cases. J Neurosurg 91:186–192
Arai Y, Takahashi M, Kurosawa H, Shitoto K (2002) Comparative study of iliac bone graft and carbon cage with local bone graft in posterior lumbar interbody fusion. J Orthop Surg (Hong Kong) 10:1–7
Brantigan JW, Steffee AD, Lewis ML, Quinn LM, Persenaire JM (2000) Lumbar interbody fusion using the Brantigan I/F cage for posterior lumbar interbody fusion and the variable pedicle screw placement system: two-year results from a Food and Drug Administration investigational device exemption clinical trial. Spine 25:1437–1446. doi:10.1097/00007632-200006010-00017
Chen L, Yang H, Tang T (2005) Cage migration in spondylolisthesis treated with posterior lumbar interbody fusion using BAK cages. Spine 30:2171–2175. doi:10.1097/01.brs.0000180402.50500.5b
Christensen FB, Hansen ES, Eiskjaer SP, Hoy K, Helmig P, Neumann P, Niedermann B, Bunger CE (2002) Circumferential lumbar spinal fusion with Brantigan cage versus posterolateral fusion with titanium Cotrel-Dubousset instrumentation: a prospective, randomized clinical study of 146 patients. Spine 27:2674–2683. doi:10.1097/00007632-200212010-00006
Closkey RF, Parsons JR, Lee CK, Blacksin MF, Zimmerman MC (1993) Mechanics of interbody spinal fusion. Analysis of critical bone graft area. Spine 18:1011–1015. doi:10.1097/00007632-199306150-00010
Eck KR, Bridwell KH, Ungacta FF, Lapp MA, Lenke LG, Riew KD (2000) Analysis of titanium mesh cages in adults with minimum two-year follow-up. Spine 25:2407–2415. doi:10.1097/00007632-200009150-00023
Elias WJ, Simmons NE, Kaptain GJ, Chadduck JB, Whitehill R (2000) Complications of posterior lumbar interbody fusion when using a titanium threaded cage device. J Neurosurg 93:45–52
Goh JC, Wong HK, Thambyah A, Yu CS (2000) Influence of PLIF cage size on lumbar spine stability. Spine 25:35–39. doi:10.1097/00007632-200001010-00008 discussion 40
Grant JP, Oxland TR, Dvorak MF (2001) Mapping the structural properties of the lumbosacral vertebral endplates. Spine 26:889–896. doi:10.1097/00007632-200104150-00012
Hollowell JP, Vollmer DG, Wilson CR, Pintar FA, Yoganandan N (1996) Biomechanical analysis of thoracolumbar interbody constructs. How important is the endplate? Spine 21:1032–1036. doi:10.1097/00007632-199605010-00007
Kim KS, Yang TK, Lee JC (2005) Radiological changes in the bone fusion site after posterior lumbar interbody fusion using carbon cages impacted with laminar bone chips: follow-up study over more than 4 years. Spine 30:655–660. doi:10.1097/01.brs.0000155421.07796.7f
Kozak JA, Heilman AE, O’Brien JP (1994) Anterior lumbar fusion options. Technique and graft materials. Clin Orthop Relat Res 4:5–51
Kuslich SD, Danielson G, Dowdle JD, Sherman J, Fredrickson B, Yuan H, Griffith SL (2000) Four-year follow-up results of lumbar spine arthrodesis using the Bagby and Kuslich lumbar fusion cage. Spine 25:2656–2662. doi:10.1097/00007632-200010150-00018
Kuslich SD, Ulstrom CL, Griffith SL, Ahern JW, Dowdle JD (1998) The Bagby and Kuslich method of lumbar interbody fusion. History, techniques, and 2-year follow-up results of a United States prospective, multicenter trial. Spine 23:1267–1278. doi:10.1097/00007632-199806010-00019 discussion 1279
Labrom RD, Tan JS, Reilly CW, Tredwell SJ, Fisher CG, Oxland TR (2005) The effect of interbody cage positioning on lumbosacral vertebral endplate failure in compression. Spine 30:E556–E561. doi:10.1097/01.brs.0000181053.38677.c2
Lim TH, Kwon H, Jeon CH, Kim JG, Sokolowski M, Natarajan R, An HS, Andersson GB (2001) Effect of endplate conditions and bone mineral density on the compressive strength of the graft-endplate interface in anterior cervical spine fusion. Spine 26:951–956. doi:10.1097/00007632-200104150-00021
McAfee PC (1999) Interbody fusion cages in reconstructive operations on the spine. J Bone Joint Surg Am 81:859–880
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 28:2386–2389. doi:10.1097/01.BRS.0000085326.73430.68
Panjabi MM, Lydon C, Vasavada A, Grob D, Crisco JJ 3rd, Dvorak J (1994) On the understanding of clinical instability. Spine 19:2642–2650
Steffen T, Tsantrizos A, Aebi M (2000) Effect of implant design and endplate preparation on the compressive strength of interbody fusion constructs. Spine 25:1077–1084. doi:10.1097/00007632-200005010-00007
Tan JS, Bailey CS, Dvorak MF, Fisher CG, Oxland TR (2005) Interbody device shape and size are important to strengthen the vertebra-implant interface. Spine 30:638–644. doi:10.1097/01.brs.0000155419.24198.35
Tullberg T, Brandt B, Rydberg J, Fritzell P (1996) Fusion rate after posterior lumbar interbody fusion with carbon fiber implant: 1-year follow-up of 51 patients. Eur Spine J 5:178–182. doi:10.1007/BF00395510
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Abbushi, A., Čabraja, M., Thomale, UW. et al. The influence of cage positioning and cage type on cage migration and fusion rates in patients with monosegmental posterior lumbar interbody fusion and posterior fixation. Eur Spine J 18, 1621–1628 (2009). https://doi.org/10.1007/s00586-009-1036-3
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DOI: https://doi.org/10.1007/s00586-009-1036-3