PLIF with a titanium cage and excised facet joint bone for degenerative spondylolisthesis--in augmentation with a pedicle screw.
OBJECTIVE
To determine the validity of posterior lumbar interbody fusion (PLIF) using a titanium cage filled with excised facet joint bone and a pedicle screw for degenerative spondylolisthesis.


METHODS
PLIF using a titanium cage filled with excised facet joint bone and a pedicle screw was performed in 28 consecutive patients (men 10, women 18). The mean age of the patients was 60 years (range, 52 to 75 y) at the time of surgery. The mean follow-up period was 2.3 years (range, 2.0 to 4.5 y). The operation was done at L3/4 in 5, L4/5 in 20, and L3/4/5 in 3 patients. The mean operative bleeding was 318+/-151 g (mean+/-standard deviation), and the mean operative time was 3.34+/-0.57 hours per fixed segment. Clinical outcome was assessed by Denis' Pain and Work scale. Radiologic assessment was done using Boxell's method. Fusion outcome was assessed using an established criteria.


RESULTS
On Pain scale, 20 and 8 patients were rated P4 and P5 before surgery, and 11, 12, 2, 2, and 1 patients were rated P1, P2, P3, P4, and P5 at final follow-up, respectively. On Work scale (for only physical labors), 12 and 9 patients were rated W4 and W5, before surgery, and 12, 5, 1, and 3 patients were rated W1, W2, W3 and W5 at final follow-up, respectively. There was significant difference in clinical outcome (P<0.01, Wilcoxon singled-rank test) The mean %Slip and Slip Angle was 17.9+/-8.1% and 3.9+/-5.8 degrees before surgery. The mean % Slip and Slip Angle was 5.4+/-4.4% and -2.0+/-4.8 degrees at final follow-up. There was a significant difference between the values (P<0.01, paired t test). "Union" and "probable union" was determined in 29 (93.5%) and 2 (6.5%) of 31 operated segments at 2.3 years (range, 2.0 to 4.5 y), postoperatively.


CONCLUSIONS
PLIF using a titanium cage filled with excised facet joint bone and a pedicle screw provided a satisfactory clinical outcome and an excellent union rate without harvesting and grafting the autologous iliac bone.
Okuyama
Koichiro
K
Department of Orthopedic Surgery, Akita Rosai Hospital, Akita 018-5604, Japan. gonn@cocoa.ocn.ne.jp
Kido
Tadato
T
Unoki
Eiki
E
Chiba
Mitsuho
M
D000368:Aged; D001863:Bone Screws / Q000592:standards / Q000639:trends; D016025:Bone Transplantation / Q000379:methods* / Q000639:trends; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D016268:Internal Fixators / Q000592:standards* / Q000639:trends; D008137:Longitudinal Studies; D017116:Low Back Pain / Q000209:etiology / Q000503:physiopathology / Q000601:surgery; D008159:Lumbar Vertebrae / Q000033:anatomy & histology / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control; D019106:Postoperative Hemorrhage; D013123:Spinal Fusion / Q000295:instrumentation* / Q000379:methods; D013168:Spondylolisthesis / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D014025:Titanium / Q000627:therapeutic use; D016896:Treatment Outcome; D021801:Zygapophyseal Joint / Q000601:surgery / Q000637:transplantation*
D014025:Titanium