Alloplastic or Autologous? Bone Chips versus PEEK Cage for Lumbar Interbody Fusion in Degenerative Spondylolisthesis

Abstract

Introduction This study was conducted to compare bone-filled intervertebral cages with autologous bone chips for instrumented lumbar interbody fusion in patients with spinal stenosis and degenerative spondylolisthesis.

Methods Surgery consisted of posterior instrumentation and decompression, diskectomy, and intervertebral fusion using a polyetheretherketone (PEEK) cage surrounded and filled with spongious bone chips (group 1, n = 57) or spongious bone chips alone (group 2, n = 37). The choice of method was left to the discretion of the surgeon. Postoperative results were prospectively evaluated using a standardized protocol. Radiological assessment included fusion rates and vertebral height, while clinical assessment included the visual analog scale (VAS) and Oswestry Disability Index (ODI).

Results In group 1, a mean of 1.38 ± 0.64 segments were fused. In group 2, a mean of 1.58 ± 0.65 segments were fused. In both groups, the VAS for back pain and leg pain and the ODI improved without significant differences between the two groups. Osseous fusion was documented by computerized tomography in 73% in group 1 and 89% in group 2 after a mean of 18 months. The loss of height was 2.8 ± 4.0% in group 1 and 2.4 ± 5.2% in group 2.

Conclusion Regardless of whether a PEEK cage filled with spongious bone chips or spongious bone chips alone were used for lumbar interbody fusion, clinical parameters improved significantly after surgery. There were no significant differences in the rate of bony fusion and loss of height between the two groups. The results of this nonrandomized cohort study indicate that the implantation of autologous spongious bone chips harvested during the decompression procedure is a useful and cheap alternative to an intervertebral cage in patients with degenerative pseudospondylolisthesis.

Keywords

degenerative - spondylolisthesis - instrumented fusion - cage - PEEK - autologous - bone chips - spongious bone

Financial Disclosures

Dr. Thomas Westermaier received payments from Medtronic for teaching activities in vascular neurosurgery and intraoperative imaging and from Raumedic for teaching activities in ICU monitoring.

Publication History

Received: 30 January 2019

Accepted: 20 December 2019

Article published online:
12 April 2021

• References

• 1 Omidi-Kashani F, Ebrahimzadeh MH, Salari S. Lumbar spondylolysis and spondylolytic spondylolisthesis: who should be have surgery? An algorithmic approach. Asian Spine J 2014; 8 (06) 856-863
• 2 Resnick DK, Watters III WC, Mummaneni PV. et al. Guideline update for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 10: lumbar fusion for stenosis without spondylolisthesis. J Neurosurg Spine 2014; 21 (01) 62-66
• 3 Kovacs FM, Urrútia G, Alarcón JD. Surgery versus conservative treatment for symptomatic lumbar spinal stenosis: a systematic review of randomized controlled trials. Spine 2011; 36 (20) E1335-E1351
• 4 Briggs H, Milligan P. Chip fusion of the low back following exploration of the spinal canal. J Bone Joint Surg Am 1944; 26: 125-130
• 5 Cloward RB. The treatment of ruptured lumbar intervertebral discs by vertebral body fusion. I. Indications, operative technique, after care. J Neurosurg 1953; 10 (02) 154-168
• 6 Rickert M, Rauschmann M, Fleege C, Behrbalk E, Harms J. Interbody fusion procedures. Development from a historical perspective. Orthopade 2015; 44 (02) 104-113
• 7 Jorgenson SS, Lowe TG, France J, Sabin J. A prospective analysis of autograft versus allograft in posterolateral lumbar fusion in the same patient. A minimum of 1-year follow-up in 144 patients. Spine 1994; 19 (18) 2048-2053
• 8 Lv C, Li X, Zhang H, Lv J, Zhang H. Comparative effectiveness of two different interbody fusion methods for transforaminal lumbar interbody fusion: cage versus morselized impacted bone grafts. BMC Musculoskelet Disord 2015; 16: 207-0675
• 9 Song D, Chen Z, Song D, Li Z. Comparison of posterior lumbar interbody fusion (PLIF) with autogenous bone chips and PLIF with cage for treatment of double-level isthmic spondylolisthesis. Clin Neurol Neurosurg 2015; 138: 111-116
• 10 Piccirilli M, Delfinis CP, Santoro A, Salvati M. Mesenchymal stem cells in lumbar spine surgery: a single institution experience about red bone marrow and fat tissue derived MSCs. J Neurosurg Sci 2017; 61 (02) 124-133
• 11 Gazzeri R, Panagiotopoulos K, Princiotto S, Agrillo U. Spontaneous spinal arthrodesis in stand-alone percutaneous pedicle screw fixation without in situ fusion in patients with lumbar segmental instability: long-term clinical, radiologic, and functional outcomes. World Neurosurg 2018; 110: e1040-e1048
• 12 Paulsen RT, Bouknaitir JB, Fruensgaard S, Carreon L, Andersen M. Prognostic factors for satisfaction after decompression surgery for lumbar spinal stenosis. Neurosurgery 2018; 82 (05) 645-651
• 13 Kanemura T, Matsumoto A, Ishikawa Y. et al. Radiographic changes in patients with pseudarthrosis after posterior lumbar interbody arthrodesis using carbon interbody cages: a prospective five-year study. J Bone Joint Surg Am 2014; 96 (10) e82