Outcomes of autograft alone versus PEEK+ autograft interbody fusion in the treatment of adult lumbar isthmic spondylolisthesis
Introduction
Posterior lumbar interbody fusion (PLIF) and internal fixation are widely used for treating lumbar spondylolisthesis and have shown good therapeutic effects [1], [2]. Autografts and interbody cages are used in PLIF. The spinous process, lamina, and facet joint obtained from decompressive surgical resection are good graft materials for PLIF [3], [4], and while the use of a cage can provide better anterior interbody support than a simple autograft, it is more expensive.
Kai et al. [3] found that the use of a bone graft containing an autologous facet joint not only can provide good anterior support but also can achieve good radiographic fusion (92.9%) and clinical results. The method described by Gill et al. for spinal decompression is the most common decompression method used for lumbar isthmic spondylolisthesis [5]. Bone resulting from a complete resection of the posterior arch using this decompression method can be cut into an autograft bone that contains the facet joint structure and morselised bone appropriate for interbody fusion. However, whether a strut autograft that contains this trimmed facet joint can produce the same clinical and radiographic outcomes as a cage interbody fusion remains unclear. Many alternative materials have been explored for use as a grafting material, such as titanium cylinders, carbon fibre cages, tantalum blocks, and polyetheretherketone (PEEK); however, PEEK cages are currently the most available and most widely used. We conducted a retrospective study comparing a local facet joint autograft alone and PEEK+ autograft in PLIF with pedicle screw internal fixation for the treatment of adult lumbar isthmic spondylolisthesis in order to evaluate the clinical and radiological outcomes.
Section snippets
General information
In total, 122 patients with single-segment lumbar isthmic spondylolisthesis who were treated with PLIF in the Spine Surgery Department of our hospital from January 2009 to January 2013 were selected for this retrospective study. Our institution’s ethics committee approved the study. The operative indications included disabling back pain and/or lower extremity pain with or without neurological symptoms refractory to at least 3 months of aggressive conservative treatment. We excluded 32 patients
Clinical results
During the postoperative follow-up period, back and leg pain VAS scores and the ODIs of patients in both groups were improved significantly (P < 0.05), but the differences between the two groups were not significant (P > 0.05) (Table 2). At the last follow-up evaluation, 84.1% (37/44) of the patients in group A and 82.5% (33/40) of the patients in group B were satisfied with the operation. The difference in satisfaction with the surgery between the two patient groups was not significant (P > 0.05) (
Discussion
With the advancement of modern surgical technology, various fusion methods have been used to treat lumbar spondylolisthesis, including anterior interbody fusion, posterior interbody fusion, posterolateral fusion, spondylolysis repair, and reduction fusion. Posterior interbody fusion and posterolateral fusion are the most common treatment methods for lumbar spondylolisthesis. Studies have shown that PLIF exhibits a higher rate of fusion than does lumbar posterolateral fusion (PLF) and may
Conclusions
The present study showed that there were no significant differences in the clinical and radiological results of the two methods used for interbody fusion, i.e., a local autogenous facet joint graft alone and PEEK + autograft; however, the insertion of an artificial PEEK cage leads to extra medical costs. Thus, an autograft excised from a complete posterior arch containing a facet joint for interbody fusion is effective and affordable in the treatment of lumbar isthmic spondylolisthesis,
Conflicts of interest
The authors have no conflicts of interest to declare.
Funding
This research did not receive any specific grants from any funding agencies in the public, commercial, or not-for-profit sectors.
Acknowledgements
We thank Drs Xingming Chen and Chengde Xia for their help in assessing the fusion status and making radiographic measurements. We would also like to thank the anonymous reviewers for their valuable comments.
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2022, Seminars in Spine SurgeryCitation Excerpt :In posterior lumbar surgery the spinous processes and lamina are also good sources of graft. If well preserved these can be cut and shaped to use as a solid interbody device, though the literature on this is lacking.4,5 Allograft can likewise be used in lieu of a synthetic cage and is still frequently used in cervical surgery, however, it is mostly historical in lumbar interbody reconstruction.6
Lumbar Interbody Fusion Devices and Approaches: When to Use What
2021, Handbook of Spine TechnologyTransforaminal Intersomatic Lumbar Arthrodesis: Comparison between Autograft and Cage in Peek
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2019, Journal of International Medical Research