COMPARISON OF EFFECTIVENESS AND RADIOLOGICAL FEATURES BETWEEN SINGLE AND DOUBLE CAGE IMPLANTING THROUGH UNILATERAL TRANSFORAMINAL LUMBAR INTERBODY FUSION_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

ZHANGShuncong ^1,2 , CUIJianchao ¹ , YANGZhidong ¹ ,  LIANGDe ¹ , MOLing ¹ , ZHANGZhida ² , TANGYongchao ¹ , LINShunxin ² , SHENGengyang ²

1. Department of Spinal Surgery, the First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou Guangdong, 510405, P. R. China;
2. the First School of Clinic Medicine, Guangzhou University of Chinese Medicine;

Corresponding?author：

LIANGDe, Email: 149504193@qq.com

Keywords：

Unilateral transforaminal lumbar interbody fusion; Intervertebral body Cage; Height of intervertebral space; Cage subsidence

DOI：

10.7507/1002-1892.20150298

Video：

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Objective To compare the effectiveness and imaging features between implanting single and double Cage into intervertebral body through unilateral transforaminal lumbar interbody fusion (TLIF). Methods The clinical data were collected and analyzed from 104 patients who underwent unilateral TLIF between January 2013 and October 2014, who were divided into 2 groups:single Cage was implanted into intervertebral body in 64 cases (76 segments) in traditional group, and double Cage was implanted into intervertebral body in 56 cases (70 segments) in reformative group. There was no significant difference in age, gender, bone mineral density, operation segments between 2 groups (P>0.05). The visual analogue scale (VAS), Oswestry disability index (ODI), and Japanese Orthopedic Association (JOA) scores were used to evaluate the effectiveness; the area of intervertebral bone-graft, fusion rate, height of intervertebral space, and the number of Cage subsidence were measured by CT scan. Results All the patients were followed up 12.85 months on average (range, 9-15 months). The VAS, ODI, and JOA scores were significantly improved at each time point after operation when compared with preoperative values (P<0.05), and no significant difference was found between 2 groups (P>0.05) except VAS and ODI at 12 months after operation (P<0.05). However, the area of intervertebral bone-graft in reformative group[(5.94±1.17) cm²] was significantly larger than that in traditional group[(4.81±0.97) cm²] at 7 days after operation (t=-6.365, P=0.000). At 3 and 12 months after operation, the fusion rate was respectively 84.2% and 92.1% in traditional group and was respectively 88.6% and 94.3% in reformative group. Although the height of intervertebral space were increased when compared with preoperative height, the incidence rates of Cages subsidence in traditional group were 44.74% and 47.37% respectively at 3 and 12 months after operation and were significantly higher those that in reformative group (11.43% and 14.29% respectively) (P<0.05). In addition, the height difference between affected side and normal side in traditional group was significantly larger than that in reformative group (P<0.05). Conclusion Both single and double Cage implanted into the intervertebral body through unilateral TLIF have good effectiveness. However, double Cage implanted into intervertebral body may hold the height of intervertebral space, reduce the incident rate of Cage subsidence, and prevent sagittal imbalance.

Citation： ZHANGShuncong, CUIJianchao, YANGZhidong, LIANGDe, MOLing, ZHANGZhida, TANGYongchao, LINShunxin, SHENGengyang. COMPARISON OF EFFECTIVENESS AND RADIOLOGICAL FEATURES BETWEEN SINGLE AND DOUBLE CAGE IMPLANTING THROUGH UNILATERAL TRANSFORAMINAL LUMBAR INTERBODY FUSION. Chinese Journal of Reparative and Reconstructive Surgery, 2015, 29(11): 1389-1396. doi: 10.7507/1002-1892.20150298 Copy

1.	Zdeblick TA, Phillips FM. Interbody cage devices. Spine (Phila Pa 1976), 2003, 28(15 Suppl):S2-7.
2.	Beutler WJ, Peppelman WC Jr. Anterior lumbar fusion with paired BAK standard and paired BAK Proximity cages:subsidence incidence, subsidence factors, and clinical outcome. Spine J, 2003, 3(4):289-293.
3.	Kim CW, Siemionow K, Anderson DG, et al. The current state of minimally invasive spine surgery. J Bone Joint Surg (Am), 2011, 93(6):582-596.
4.	Deyo RA, Gray DT, Kreuter W, et al. United States trends in lumbar fusion surgery for degenerative conditions. Spine (Phila Pa 1976), 2005, 30(12):1441-1447.
5.	Chen WJ, Tsai TT, Chen LH, et al. The fusion rate of calcium sulfate with local autograft bone compared with autologous iliac bone graft for instrumented short-segment spinal fusion. Spine (Phila Pa 1976), 2005, 30(20):2293-2297.
6.	Jiya TU, Smit T, van Royen BJ, et al. Posterior lumbar interbody fusion using non resorbable poly-ether-ether-ketone versus resorbable poly-L-lactide-co-D, L-lactide fusion devices. Clinical outcome at a minimum of 2-year follow-up. Eur Spine J, 2011, 20(4):618-622.
7.	Hackenberg L, Halm H, Bullmann V, et al. Transforaminal lumbar interbody fusion:a safe technique with satisfactory three to five year results. Eur Spine J, 2005, 14(6):551-558.
8.	Lowe TG, Tahernia AD. Unilateral transforaminal posterior lumbar interbody fusion. Clin Orthop Relat Res, 2002, (394):64-72.
9.	Yu AK, Siegfried CM, Chew B, et al. Biomechanics of posterior dynamic fusion systems in the lumbar spine:implications for stabilization with improved arthrodesis. J Spinal Disord Tech, 2012.[Epub ahead of print].
10.	Choi JY, Sung KH. Subsidence after anterior lumbar interbody fusion using paired stand-alone rectangular cages. Eur Spine J, 2006, 15(1):16-22.
11.	Sakeb N, Ahsan K. Comparison of the early results of transforaminal lumbar interbody fusion and posterior lumbar interbody fusion in symptomatic lumbar instability. Indian J Orthop, 2013, 47(3):255-263.
12.	Huang KT, Hazzard M, Thomas S, et al. Differences in the outcomes of anterior versus posterior interbody fusion surgery of the lumbar spine:A propensity score-controlled cohort analysis of 10,941 patients. J Clin Neurosci, 2015, 22(5):848-853.
13.	Wang JC, Mummaneni PV, Haid RW. Current treatment strategies for the painful lumbar motion segment:posterolateral fusion versus interbody fusion. Spine (Phila Pa 1976), 2005, 30(16 Suppl):S33-43.
14.	Kuslich SD, Danielson G, Dowdle JD, et al. Four-year follow-up results of lumbar spine arthrodesis using the Bagby and Kuslich lumbar fusion cage. Spine (Phila Pa 1976), 2000, 25(20):2656-2662.
15.	Brodke DS, Dick JC, Kunz DN, et al. Posterior lumbar interbody fusion. A biomechanical comparison, including a new threaded cage. Spine (Phila Pa 1976), 1997, 22(1):26-31.
16.	Ding JY, Qian S, Wan L, et al. Design and finite-element evaluation of a versatile assembled lumbar interbody fusion cage. Arch Orthop Trauma Surg, 2010, 130(4):565-571.
17.	McAfee PC, Lee GA, Fedder IL, et al. Anterior BAK instrumentation and fusion:complete versus partial discectomy. Clin Orthop Relat Res, 2002, (394):55-63.
18.	Nord RM, Sandhu HS, Khan SN, et al. Threaded cortical bone dowels in lumbosacral arthrodesis:a review. Clin Orthop Relat Res, 2003, (414):101-111.
19.	Ito Z, Imagama S, Kanemura T, et al. Volumetric change in interbody bone graft after posterior lumbar interbody fusion (PLIF):a prospective study. Eur Spine J, 2014, 23(10):2144-2149.
20.	McAfee PC. Interbody fusion cages in reconstructive operations on the spine. J Bone Joint Surg (Am), 1999, 81(6):859-880.
21.	Oxland TR, Lund T. Biomechanics of stand-alone cages and cages in combination with posterior fixation:a literature review. Eur Spine J, 2000, 9 Suppl 1:S95-101.
22.	Marchi L, Abdala N, Oliveira L, et al. Radiographic and clinical evaluation of cage subsidence after stand-alone lateral interbody fusion. J Neurosurg Spine, 2013, 19(1):110-118.
23.	Faizan A, Kiapour A, Kiapour AM, et al. Biomechanical analysis of various footprints of transforaminal lumbar interbody fusion devices. J Spinal Disord Tech, 2014, 27(4):E118-127.
24.	Corniola MV, Jagersberg M, Stienen MN, et al. Complete cage migration/subsidence into the adjacent vertebral body after posterior lumbar interbody fusion. J Clin Neurosci, 2015, 22(3):597-598.
25.	Le TV, Baaj AA, Dakwar E, et al. Subsidence of Polyetheretherketone intervertebral cages in minimally invasive lateral retroperitoneal transpsoas lumbar interbody fusion. Spine (Phila Pa 1976), 2012, 37(14):1268-1273.
26.	Harris BM, Hilibrand AS, Savas PE, et al. Transforaminal lumbar interbody fusion:the effect of various instrumentation techniques on the flexibility of the lumbar spine. Spine (Phila Pa 1976), 2004, 29(4):E65-70.
27.	Ames CP, Acosta FL Jr, Chi J, et al. Biomechanical comparison of posterior lumbar interbody fusion and transforaminal lumbar interbody fusion performed at 1 and 2 levels. Spine (Phila Pa 1976), 2005, 30(19):E562-566.
28.	Yan DL, Pei FX, Li J, et al. Comparative study of PILF and TLIF treatment in adult degenerative spondylolisthesis. Eur Spine J, 2008, 17(10):1311-1316.
29.	Kimura H, Shikata J, Odate S, et al. Risk factors for cage retropulsion after posterior lumbar interbody fusion:analysis of 1070 cases. Spine (Phila Pa 1976), 2012, 37(13):1164-1169.
30.	Kepler CK, Rihn JA, Radcliff KE, et al. Restoration of lordosis and disk height after single-level transforaminal lumbar interbody fusion. Orthop Surg, 2012, 4(1):15-20.

1. Zdeblick TA, Phillips FM. Interbody cage devices. Spine (Phila Pa 1976), 2003, 28(15 Suppl):S2-7.
2. Beutler WJ, Peppelman WC Jr. Anterior lumbar fusion with paired BAK standard and paired BAK Proximity cages:subsidence incidence, subsidence factors, and clinical outcome. Spine J, 2003, 3(4):289-293.
3. Kim CW, Siemionow K, Anderson DG, et al. The current state of minimally invasive spine surgery. J Bone Joint Surg (Am), 2011, 93(6):582-596.
4. Deyo RA, Gray DT, Kreuter W, et al. United States trends in lumbar fusion surgery for degenerative conditions. Spine (Phila Pa 1976), 2005, 30(12):1441-1447.
5. Chen WJ, Tsai TT, Chen LH, et al. The fusion rate of calcium sulfate with local autograft bone compared with autologous iliac bone graft for instrumented short-segment spinal fusion. Spine (Phila Pa 1976), 2005, 30(20):2293-2297.
6. Jiya TU, Smit T, van Royen BJ, et al. Posterior lumbar interbody fusion using non resorbable poly-ether-ether-ketone versus resorbable poly-L-lactide-co-D, L-lactide fusion devices. Clinical outcome at a minimum of 2-year follow-up. Eur Spine J, 2011, 20(4):618-622.
7. Hackenberg L, Halm H, Bullmann V, et al. Transforaminal lumbar interbody fusion:a safe technique with satisfactory three to five year results. Eur Spine J, 2005, 14(6):551-558.
8. Lowe TG, Tahernia AD. Unilateral transforaminal posterior lumbar interbody fusion. Clin Orthop Relat Res, 2002, (394):64-72.
9. Yu AK, Siegfried CM, Chew B, et al. Biomechanics of posterior dynamic fusion systems in the lumbar spine:implications for stabilization with improved arthrodesis. J Spinal Disord Tech, 2012.[Epub ahead of print].
10. Choi JY, Sung KH. Subsidence after anterior lumbar interbody fusion using paired stand-alone rectangular cages. Eur Spine J, 2006, 15(1):16-22.
11. Sakeb N, Ahsan K. Comparison of the early results of transforaminal lumbar interbody fusion and posterior lumbar interbody fusion in symptomatic lumbar instability. Indian J Orthop, 2013, 47(3):255-263.
12. Huang KT, Hazzard M, Thomas S, et al. Differences in the outcomes of anterior versus posterior interbody fusion surgery of the lumbar spine:A propensity score-controlled cohort analysis of 10,941 patients. J Clin Neurosci, 2015, 22(5):848-853.
13. Wang JC, Mummaneni PV, Haid RW. Current treatment strategies for the painful lumbar motion segment:posterolateral fusion versus interbody fusion. Spine (Phila Pa 1976), 2005, 30(16 Suppl):S33-43.
14. Kuslich SD, Danielson G, Dowdle JD, et al. Four-year follow-up results of lumbar spine arthrodesis using the Bagby and Kuslich lumbar fusion cage. Spine (Phila Pa 1976), 2000, 25(20):2656-2662.
15. Brodke DS, Dick JC, Kunz DN, et al. Posterior lumbar interbody fusion. A biomechanical comparison, including a new threaded cage. Spine (Phila Pa 1976), 1997, 22(1):26-31.
16. Ding JY, Qian S, Wan L, et al. Design and finite-element evaluation of a versatile assembled lumbar interbody fusion cage. Arch Orthop Trauma Surg, 2010, 130(4):565-571.
17. McAfee PC, Lee GA, Fedder IL, et al. Anterior BAK instrumentation and fusion:complete versus partial discectomy. Clin Orthop Relat Res, 2002, (394):55-63.
18. Nord RM, Sandhu HS, Khan SN, et al. Threaded cortical bone dowels in lumbosacral arthrodesis:a review. Clin Orthop Relat Res, 2003, (414):101-111.
19. Ito Z, Imagama S, Kanemura T, et al. Volumetric change in interbody bone graft after posterior lumbar interbody fusion (PLIF):a prospective study. Eur Spine J, 2014, 23(10):2144-2149.
20. McAfee PC. Interbody fusion cages in reconstructive operations on the spine. J Bone Joint Surg (Am), 1999, 81(6):859-880.
21. Oxland TR, Lund T. Biomechanics of stand-alone cages and cages in combination with posterior fixation:a literature review. Eur Spine J, 2000, 9 Suppl 1:S95-101.
22. Marchi L, Abdala N, Oliveira L, et al. Radiographic and clinical evaluation of cage subsidence after stand-alone lateral interbody fusion. J Neurosurg Spine, 2013, 19(1):110-118.
23. Faizan A, Kiapour A, Kiapour AM, et al. Biomechanical analysis of various footprints of transforaminal lumbar interbody fusion devices. J Spinal Disord Tech, 2014, 27(4):E118-127.
24. Corniola MV, Jagersberg M, Stienen MN, et al. Complete cage migration/subsidence into the adjacent vertebral body after posterior lumbar interbody fusion. J Clin Neurosci, 2015, 22(3):597-598.
25. Le TV, Baaj AA, Dakwar E, et al. Subsidence of Polyetheretherketone intervertebral cages in minimally invasive lateral retroperitoneal transpsoas lumbar interbody fusion. Spine (Phila Pa 1976), 2012, 37(14):1268-1273.
26. Harris BM, Hilibrand AS, Savas PE, et al. Transforaminal lumbar interbody fusion:the effect of various instrumentation techniques on the flexibility of the lumbar spine. Spine (Phila Pa 1976), 2004, 29(4):E65-70.
27. Ames CP, Acosta FL Jr, Chi J, et al. Biomechanical comparison of posterior lumbar interbody fusion and transforaminal lumbar interbody fusion performed at 1 and 2 levels. Spine (Phila Pa 1976), 2005, 30(19):E562-566.
28. Yan DL, Pei FX, Li J, et al. Comparative study of PILF and TLIF treatment in adult degenerative spondylolisthesis. Eur Spine J, 2008, 17(10):1311-1316.
29. Kimura H, Shikata J, Odate S, et al. Risk factors for cage retropulsion after posterior lumbar interbody fusion:analysis of 1070 cases. Spine (Phila Pa 1976), 2012, 37(13):1164-1169.
30. Kepler CK, Rihn JA, Radcliff KE, et al. Restoration of lordosis and disk height after single-level transforaminal lumbar interbody fusion. Orthop Surg, 2012, 4(1):15-20.

Chinese Journal of Reparative and Reconstructive Surgery

COMPARISON OF EFFECTIVENESS AND RADIOLOGICAL FEATURES BETWEEN SINGLE AND DOUBLE CAGE IMPLANTING THROUGH UNILATERAL TRANSFORAMINAL LUMBAR INTERBODY FUSION

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