Preliminary application of one-level posterior lumbar interbody fusion with prospace and facet fusion using local autograft.
OBJECTIVE
To evaluate the safety and efficacy of one-level posterior lumbar interbody fusion (PLIF) combined with Prospace and facet fusion using local autograft.


METHODS
Clinical and radiographic data of 76 patients treated by this technique was reviewed from May 2002 to December 2004. Of them, there were 52 males and 24 females, with an average age of 53.2 years (23-81 years), including 60 cases of degenerative disc disease, 9 cases of failed back surgery syndrome and 3 cases of spondylolysis.The disese courses were 1.2-8.7 years (mean 3.6 years). The levels of PLIF were: L2,3 in 2 cases, L3,4 in 7, L4,5 in 54, L5/S1 in 10, L4/ S1 in 1 and L5,6 in 2. After decompression, Prospace was inserted into interbody space bilaterally, and located in disc space 4 mm beyond the rear edge of the vertebral body. Local laminectomy autograft was packed both laterally into and between 2 implants. Then the remanent local autograft was placed over facet bed. Pedicle screws were used after insertion of Prospace. Clinical results were evaluated by the JOA score. Disc height ratio and lumbar lordosis angles were measured on lateral radiographs. Fusion status was determined by evidence of bridge trabeculae across facet joint and interbody space on CT scan without mobility in lateral dynamic X-rays, and no radiolucent gap between Prospace and endplate. Paired t-test was used for statistical analysis.


RESULTS
Mean blood loss and operative time was 384 ml and 178 minutes, respectively. The average JOA score at final follow-up (26.1 +/- 2.7) was significantly improved when compared with that of pre-operation (14.5 +/- 4.0, P < 0.05), with a mean recovery rate of JOA score 81.1% (37.5%-100.0%). The fusion rate was 97.4% (74/76). Mean disc height ratio and the involved segmental lordosis angle were increased from preoperative 0.27 +/- 0.07 and 5.8 +/- 2.2 degrees to 0.33 +/- 0.06 and 11.3 +/- 2.0 degrees respectively at the final follow-up, and the differences were significant (P < 0.05). There were no device-related complications.


CONCLUSIONS
This surgical technique combined with Prospace interbody device is a safe and effective surgical option for patients with one-level lumbar disorders when PLIF is warranted.
Long
Houqing
H
Department of Spine Surgery, The First Affiliated Hospital of Sun-Yat-Sen University, Guangzhou Guangdong, 510700, PR China. houqinglong@163.com
Kazunasa
Ueyama
U
Liu
Shaoyu
S
Akio
Sannohe
S
Taito
Itabashi
I
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016025:Bone Transplantation / Q000379:methods; D019299:Decompression, Surgical / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016268:Internal Fixators; D007405:Intervertebral Disc Displacement / Q000601:surgery; D008159:Lumbar Vertebrae / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013122:Spinal Diseases / Q000601:surgery*; D013123:Spinal Fusion / Q000295:instrumentation / Q000379:methods*; D013130:Spinal Stenosis / Q000601:surgery; D013168:Spondylolisthesis / Q000601:surgery; D014182:Transplantation, Autologous; D016896:Treatment Outcome; D055815:Young Adult