Outcomes of autograft alone versus PEEK+ autograft interbody fusion in the treatment of adult lumbar isthmic spondylolisthesis

Highlights

• A local facet joint autograft alone and PEEK + autograft in PLIF were compared.

• The two methods showed similar clinical and radiological results.

• An artificial PEEK cage leads to extra medical costs.

• A local facet joint autograft alone is effective and affordable in PLIF.

Abstract

Objectives

Bone resulting from a complete resection of the posterior arch can be cut into an autograft bone that contains the facet joint structure and morselised bone 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 for interbody fusion remains unclear. The aim of this study was to compare the outcomes of a local facet joint autograft alone to those of polyetheretherketone (PEEK) + autograft for posterior lumbar interbody fusion (PLIF) in the treatment of adult isthmic spondylolisthesis.

Patients and methods

A retrospective analysis was performed on 84 patients with single lumbar isthmic spondylolisthesis who were treated with a local facet joint autograft alone (group A; n = 44) or PEEK + autograft (group B; n = 40) in PLIF with a minimum follow-up period of 24 months. Pain and disability were assessed using the visual analogue scale, Oswestry disability index and Kirkaldy-Willis criteria. In the radiological evaluation, disc height, slippage reduction, and fusion status were examined. Postoperative complications were also monitored.

Results

At the last follow-up examination, 84.1% (37/44) of the patients in group A and 82.5% (33/40) of the patients in group B had a good outcome, and there were no significant differences between the two groups. Boh Methods led to significant improvements in disc height, and while PEEK + autograft produced a smaller loss in disc height, the difference was insignificant. The improvements in slippage and the fusion and complication rates between the two groups were similar.

Conclusion

There were no significant differences in the clinical outcomes or radiographic improvements of both fusion methods in the treatment of adult isthmic spondylolisthesis. An autograft excised from a complete posterior arch containing a facet joint for interbody fusion is effective and affordable for treating 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.