108 - Trabecular Metal (TM) Cages in PLIF for Lumbar Spine Disorders - Resul...

#108 Trabecular Metal (TM) Cages in PLIF for Lumbar Spine Disorders - Result of a Prospective Study

Lumbar Therapies and Outcomes

Poster Presented by: M. Elmalky

Author(s):

M. Elmalky (1)
S. Cadman (2)
I. Shackleford (2)

(1) Salford Royal NHS Trust, Manchester, United Kingdom
(2) Warrington Hospital NHS Trust, Liverpool, United Kingdom

Abstract

Design: Three-year prospective study.

Objective:To evaluate results of instrumented posterior lumbar interbody fusion (PLIF) when augmented with TM cages and Actifuse in lumbar disorders.

Background: Spinal surgeons have the option of treating low back pain using PLIF. This procedure was studied over the past 60 years. Recently, different cages and graft options are available in the market.

Materials and Methods: Thirty six patients underwent PLIF augmented with TM spacer and Actifuse between 2007-2010. We followed specific inclusion and exclusion criteria. All cases experienced minimum 6 months low back pain failed conservative treatment. Clinical and radiological evaluation was performed preoperatively.

On follow-up, x-rays and clinical outcome measures including visual analogue pain scale (VAS) & Oswestry Disability Index (ODI) were obtained. Interbody and posterolateral fusion were assessed according to specific fusion criteria. Lumbar lordosis angle (LLA), segmental lumbar lordosis angle (SLLA), anterior disc height (ADH) and posterior disc height (PDH) were measured.

Results: The mean age was 45.6 (21-65 years). Eleven patients had two-level fusion and 25 had one-level. Eighteen patients had DDD, spondylolisthesis (11) and spinal stenosis (7). The mean follow up was 2.47 years.

ODI and VAS improvement were 60.2% and 64.8% respectively (P< 0.05). Solid interbody fusion achieved in 34pt (94.4%) and two had probable fusion. Lenke type A&B posterolateral fusions were detected in 29pt. (80.6%). LLA and SLLA only decreased by2.7° and 2.4° respectively. Reduction in ADH was 2.1mm and 1.6mm inPDH. The mean operative time for one-level was 120min (with blood loss 400-800ml) and 180min for two-level with (700-1500 blood loss). One case had superficial infection, one transient neuropathic pain, (1%) screw misdirection and one adjacent level disease (none warranted revision).

Conclusion: PLIF is effective procedure for low back pain carefully performed. TM cages and Actifuse provide high fusion and clinical outcomes. They save op-time, blood loss and avoid autologus graft donor-site morbidities. TM cages maintain lumbar profile. Our results are equal/superior to others. Long-term studies are recommended to evaluate new technologies. Modern spinal surgeon should update their skills to best address the painful motion segment.