Effects of compression and non-compression fusion cage on lumbar fusion

doi:10.3969/j.issn.2095-4344.2016.35.003

Abstract

Abstract:

BACKGROUND: The posterior lumbar interbody fusion is one of the effective methods for the treatment of lumbar and sacral spine diseases. Most surgeons fix the cage by compressing the disc space in order to keep stability and prevent dislodgement. However, some surgeons think that the non-compression technique does favor for increasing of the disc and foraminal height and thus improving the clinical outcomes, and does not increase the risk of fusion shift.

OBJECTIVE: To compare the effects in fixing the cage by the compression and non-compression techniques on posterior lumbar interbody fusion.

METHODS: Data of 64 patients with single-segment lumbar degeneration undergoing posterior lumbar interbody fusion between August 2009 and June 2014 were retrospectively analyzed. Fusion device was fixed according to compression of intervertebral space. These patients were divided into compression group (n=30) and non-compression group (n=34).

RESULTS AND CONCLUSION: (1) Curative effects: Lumbar and leg pain visual analogue score, Oswestry disability index, SF-36 score and the height of intervertebral space, intervertebral foramen height and lumbar lordosis were significantly improved postoperatively in each group compared with preoperatively (P < 0.05). The intervertebral space, intervertebral foramen height and lumbar lordosis were significantly better in the non-compression group than in the compression group (P < 0.05). (2) Lumbar fusion rate: No significant difference in lumbar fusion rate was detected 6 and 12 months after surgery and during final follow-up (P > 0.05). (3) Correlation analysis: The increase of the intervertebral space and the height of the intervertebral foramen were not significantly correlated with the improvement of the clinical curative effect (P > 0.05). (4) Test results demonstrated that outcomes of the compression technique to fix the cage are equivalent to the non-compression in posterior lumbar interbody fusion. Non-compression is advantageous to increase the intervertebral space and the height of the intervertebral foramen. Both of them are conducive to the recovery of lumbar lordosis, but are not correlated with the increase in clinical curative effect.

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

Key words: Tissue Engineering, Lumbar Vertebrae, Intervertebral Disk

CLC Number:

R318

Gu Yong, Wang Ling-jun, Chen Liang. Effects of compression and non-compression fusion cage on lumbar fusion[J]. Chinese Journal of Tissue Engineering Research, 2016, 20(35): 5187-5194.

Figures/Tables 3

2.4 两组腰椎影像学特点术后每组椎间隙高度、椎间孔高度及腰椎前凸角均较术前明显改善(P < 0.05；表3)；而术后不同时刻差异均无显著性意义。术后不同时刻，不加压组的椎间隙高度、椎间孔高度及腰椎前凸角均高于加压组(P < 0.05)。术后6个月时加压组融合率为76.7%，不加压组融合率为70.6%，两组差异无显著性意义；术后12个月时融合率分别为93.3%及91.2%；而末次随访时分别为100%及97.1%，两组差异均无显著性意义。 2.5 两组疗效与影像学之间的相关性加压组椎间隙及椎间孔高度的增加与腿痛目测类比评分、Oswestry功能障碍指数及SF-36评分的改善无明显相关性(椎间隙高度与腿痛目测类比评分：r=-0.23，P=0.23；椎间隙高度与Oswestry功能障碍指数：r=-0.19，P=0.35；椎间隙高度与SF-36：r=0.08，P=0.69；椎间孔高度与腿痛目测类比评分：r=0.06，P=0.75；椎间孔高度与Oswestry功能障碍指数：r=0.22，P=0.25；椎间孔高度与SF-36：r=0.00，P=1.00)。不加压组椎间隙及椎间孔高度的增加与腿痛目测类比评分、Oswestry功能障碍指数及SF-36评分的改善也无相关性(椎间隙高度与腿痛目测类比评分：r= 0.07，P=0.68；椎间隙高度与Oswestry功能障碍指数：r=0.18，P=0.32；椎间隙高度与SF-36：r=0.05，P=0.79。椎间孔高度与腿痛目测类比评分：r=-0.28，P=0.11；椎间孔高度与Oswestry功能障碍指数：r=-0.04，P=0.83；椎间孔高度与SF-36：r=-0.23，P=0.19)。 2.6 两组并发症情况分析加压组1例硬膜囊撕裂，予以缝合，术后无脑脊液漏；2例患侧下肢根性痛加重，1例出现对侧下肢根性痛，予以脱水消肿及神经营养，3周内好转。不加压组2例硬膜囊撕裂，予以缝合，其中1例脑脊液漏，予以头低脚高位，切口加压包扎，换药2周，伤口愈合；1例患肢根性痛加重，神经营养2周后恢复。随访期间未见椎弓根螺钉松动或断裂，或融合器移位。 2.7 典型病例患者，女，49岁，L5/S1椎间盘突出伴不稳症，施行腰椎后路椎体间融合，椎间融合器予以加压固定，随访17个月，无融合器移位或下沉，无椎弓根螺钉松动或断裂，见图2。"

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