Application of modified direction-changeable lumbar Cage in transforaminal lumbar interbody fusion_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

ZHANG Haiping ,  HAO Dingjun , HE Baorong , ZHAO Qinpeng , WANG Xiaodong , LIU Tuanjiang , HE Simin

Department of Spine Surgery, Honghui Hospital Affiliated to Medical School of Xi’an Jiao Tong University, Xi’an Shaanxi, 710054, P.R.China;

Corresponding?author：

HAO Dingjun, Email: haodingjundr@163.com

Keywords：

Lumbar Cage; transforaminal lumbar interbody fusion; spondylolisthesis

DOI：

10.7507/1002-1892.201806125

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Objective To investigate the effectiveness of modified direction-changeable lumbar Cage in transforaminal lumbar interbody fusion (TLIF).Methods A retrospective analysis was made of 161 patients with single segment L₄ or L₅ isthmic spondylolisthesis treated between January 2013 and December 2015. According to the implantation of Cage, they were divided into trial group (85 cases, modified direction-changeable lumbar Cage implanted in TLIF) and control group (76 cases, traditional nondirection-changeable Cage implanted in TLIF). There was no significant difference in the general data of gender, age, disease duration, slippage segment, and slippage grade between the two groups (P>0.05). The intraoperative implantation time of Cage, Cage position adjustments times, fluoroscopy times during implantation of Cage, fluoroscopy exposure time, and total operation time were recorded and compared between the two groups. Visual analogue scale (VAS) and Oswestry disability index (ODI) scores were used to evaluate the effectiveness of the patients before operation, and at 3, 6, and 12 months after operation, and the incidence of complications was recorded and analyzed. CT examinations were performed at 6 and 12 months after operation, and lumbar fusion was evaluated by Bridwell criteria.Results The intraoperative implantation time of Cage, Cage position adjustments times, fluoroscopy times during implantation of Cage, fluoroscopy exposure time, and total operation time in trial group were significant less than those in control group (P<0.05). All the 161 patients were followed up 12-18 months (mean, 14.3 months). There was 1 case of dural sac tear in the trial group and 1 case of superficial infection in the control group; no complication such as dural tear and infection occurred in other patients. The fusion rate was 76.5% (64/85) in the trial group and 57.9% (44/76) in the control group at 6 months after operation, showing significant difference (χ²=6.44, P=0.02); at 12 months after operation, the fusion rate was 96.5% (82/85) in the trial group and 90.8% (69/76) in the control group (including 3 cases of Cage displacement and 4 cases of screw breakage), showing no significant difference in the fusion rate between the two groups (χ²=1.54, P=0.26). The VAS and ODI scores of the two groups decreased gradually at 3, 6, and 12 months after operation, and improved significantly when compared with those before operation (P<0.05). There was no significant difference in VAS and ODI scores between the two groups before and after operation (P>0.05).Conclusion Both Cages can obtain the similar effectiveness. The modified direction-changeable lumbar Cage can significantly reduce the fluoroscopy times and radiation dose during TLIF, shorten the operation time, and effectively reduce the radiation exposure of patients and medical staff.

Citation： ZHANG Haiping, HAO Dingjun, HE Baorong, ZHAO Qinpeng, WANG Xiaodong, LIU Tuanjiang, HE Simin. Application of modified direction-changeable lumbar Cage in transforaminal lumbar interbody fusion. Chinese Journal of Reparative and Reconstructive Surgery, 2019, 33(4): 410-415. doi: 10.7507/1002-1892.201806125 Copy

1.	郜德龍, 方忠, 孫允龍, 等. 同種異體骨 Cage 在經椎間孔腰椎椎間融合手術中的應用. 中國修復重建外科雜志, 2018, 32(7): 927-932.
2.	Chaudhary MM. Infected nonunion of tibia. Indian J Orthop, 2017, 51(3): 256-268.
3.	Chen L, Yang H, Tang T. Cage migration in spondylolisthesis treated with posterior lumbar interbody fusion using BAK cages. Spine (Phila Pa 1976), 2005, 30(19): 2171-2175.
4.	張建鋒, 周志杰, 趙鳳東, 等. 腰椎融合器后移的重要因素——間隙上終板后部損傷. 中華骨科雜志, 2016, 36(14): 914-920.
5.	Zhang H, Jiang Y, Wang B, et al. Direction-changeable lumbar cage versus traditional lumbar cage for treating lumbar spondylolisthesis: A retrospective study. Medicine (Baltimore), 2018, 97(7): e9984.
6.	郝建學, 周斐, 鐘娜, 等. 椎間植骨量對腰椎椎間融合內固定術后融合效果的研究. 實用骨科雜志, 2016, 22(3): 205-208, 245.
7.	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.
8.	Abbushi A, Cabraja 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, 2009, 18(11): 1621-1628.
9.	苗驚雷, 張朝躍, 詹瑞森, 等. 置入椎間融合器行腰椎融合后 Cage 移位的原因. 中國組織工程研究與臨床康復, 2011, 15(39): 7307-7310.
10.	Zhao FD, Yang W, Shan Z, et al. Cage migration after transforaminal lumbar interbody fusion and factors related to it. Orthop Surg, 2012, 4(4): 227-232.
11.	趙軍然. 腰椎后路椎間植骨融合術后 Cage 后移的相關因素分析. 頸腰痛雜志, 2017, 38(2): 106-110.
12.	陳家麟, 茅祖斌, 吳小濤. 四種經椎間孔腰椎間融合固定方式的三維有限元分析. 中國組織工程研究與臨床康復, 2008, 12(39): 7605-7610.
13.	甘鋒平, 譚海濤, 江建中, 等. 直接外側入路椎間融合術治療腰椎退變性疾病療效觀察. 中國修復重建外科雜志, 2016, 30(6): 716-720.
14.	Villard J, Ryang YM, Demetriades AK, et al. Radiation exposure to the surgeon and the patient during posterior lumbar spinal instrumentation: a prospective randomized comparison of navigated versus non-navigated freehand techniques. Spine (Phila Pa 1976), 2014, 39(13): 1004-1009.
15.	Erken HY, Burc H, Saka G, et al. Can radiation exposure to the surgeon be reduced with freehand pedicle screw fixation technique in pediatric spinal deformity correction? A prospective multicenter study Spine (Phila Pa 1976), 2014, 39(6): 521-525.

1. 郜德龍, 方忠, 孫允龍, 等. 同種異體骨 Cage 在經椎間孔腰椎椎間融合手術中的應用. 中國修復重建外科雜志, 2018, 32(7): 927-932.
2. Chaudhary MM. Infected nonunion of tibia. Indian J Orthop, 2017, 51(3): 256-268.
3. Chen L, Yang H, Tang T. Cage migration in spondylolisthesis treated with posterior lumbar interbody fusion using BAK cages. Spine (Phila Pa 1976), 2005, 30(19): 2171-2175.
4. 張建鋒, 周志杰, 趙鳳東, 等. 腰椎融合器后移的重要因素——間隙上終板后部損傷. 中華骨科雜志, 2016, 36(14): 914-920.
5. Zhang H, Jiang Y, Wang B, et al. Direction-changeable lumbar cage versus traditional lumbar cage for treating lumbar spondylolisthesis: A retrospective study. Medicine (Baltimore), 2018, 97(7): e9984.
6. 郝建學, 周斐, 鐘娜, 等. 椎間植骨量對腰椎椎間融合內固定術后融合效果的研究. 實用骨科雜志, 2016, 22(3): 205-208, 245.
7. 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.
8. Abbushi A, Cabraja 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, 2009, 18(11): 1621-1628.
9. 苗驚雷, 張朝躍, 詹瑞森, 等. 置入椎間融合器行腰椎融合后 Cage 移位的原因. 中國組織工程研究與臨床康復, 2011, 15(39): 7307-7310.
10. Zhao FD, Yang W, Shan Z, et al. Cage migration after transforaminal lumbar interbody fusion and factors related to it. Orthop Surg, 2012, 4(4): 227-232.
11. 趙軍然. 腰椎后路椎間植骨融合術后 Cage 后移的相關因素分析. 頸腰痛雜志, 2017, 38(2): 106-110.
12. 陳家麟, 茅祖斌, 吳小濤. 四種經椎間孔腰椎間融合固定方式的三維有限元分析. 中國組織工程研究與臨床康復, 2008, 12(39): 7605-7610.
13. 甘鋒平, 譚海濤, 江建中, 等. 直接外側入路椎間融合術治療腰椎退變性疾病療效觀察. 中國修復重建外科雜志, 2016, 30(6): 716-720.
14. Villard J, Ryang YM, Demetriades AK, et al. Radiation exposure to the surgeon and the patient during posterior lumbar spinal instrumentation: a prospective randomized comparison of navigated versus non-navigated freehand techniques. Spine (Phila Pa 1976), 2014, 39(13): 1004-1009.
15. Erken HY, Burc H, Saka G, et al. Can radiation exposure to the surgeon be reduced with freehand pedicle screw fixation technique in pediatric spinal deformity correction? A prospective multicenter study Spine (Phila Pa 1976), 2014, 39(6): 521-525.

Chinese Journal of Reparative and Reconstructive Surgery

Application of modified direction-changeable lumbar Cage in transforaminal lumbar interbody fusion

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