The Use of Titan and PEEK Implants in Stand Alone ALIF Surgery for Degenerative Disease of the Lumbosacral Spine – a Prospective Study


Authors: L. Hrabálek 1;  I. Rešková 1;  J. Bučil 2;  M. Vaverka 1;  M. Houdek 1
Authors‘ workplace: Neurochirurgická klinika LF UP a FN Olomouc 1;  Radiologická klinika LF UP a FN Olomouc 2
Published in: Cesk Slov Neurol N 2009; 72/105(1): 38-44
Category: Original Paper

Overview

The use of cages is one of the methods to obtain anterior lumbar fusion (ALIF). The study reviews the clinical results in correlation with radiological findings for two types of implants: a titan implant (SynCage, Synthes, USA) is compared with a PEEK implant (Visios, Synthes, USA) used in a stand-alone ALIF surgery in patients with degenerative disease of the lumbosacral spine. The set of patients is made up of two identical groups each consisting of 14 patients, with a follow-up time of at least one year. The correlations between the clinical findings expressed by Visual Analogue Scale, Oswestry Disability Index and neurological examination and the CT and MRI findings prior to surgery and one year post-op were assessed by standard statistical methods. The presence of Modic changes type 1 in MRI one year post-op was associated with a lower degree of improvement of clinical status as compared with other Modic changes. Modic changes type 1 developed post-op in five patients (35.7%) with a PEEK implant. Cystic bone changes detected by CT one year after the implantation of PEEK cages was recorded in eight patients (57.1%) and was also associated with a lower degree of improvement of clinical status as compared with patients without such changes. Implant-based comparison of the two groups of patients showed worse clinical results for the patients with a PEEK implant. Modic changes type 1 in MRI images and bone cysts in CT findings probably reflect insufficient healing of the PEEK implant in the stand-alone ALIF procedure. Additional posterior transpedicular fixation and subsequent increase of stability reduces the number of the above-mentioned CT and MRI findings and results in an improved clinical status. The authors therefore recommend only the titan implant for stand-alone ALIF. The PEEK implant should be used only with posterior transpedicular fixation and is not suitable for the stand-alone ALIF procedure.

Key words:
lumbar spine – ALIF – magnetic resonance imaging – Modic changes – titan implant – PEE K implant – SynCage – Visios


Sources

1. Carlsson AM. Assessment of chronic pain. I. Aspects of the reliability and validity of the visual analogue scale. Pain 1983; 16(1): 87–101.

2. Fairbank JC, Pynsent PB. The Oswestry Disability Index. Spine 2000; 25(22): 2940–2953.

3. Modic MT, Steinberg PM, Ross JS, Masaryk TJ, Carter JR. Degenerative disc disease: assessment of changes in vertebral body marrow with MR Imaging. Radiology 1988; 166(1): 193–199.

4. Pavlov PW, Meijers H, van Limbeek J, Jacobs WCH, Lemmens AM, Obradov-Rajic M et al. Good outcome and restoration of lordosis after anterior lumbar interbody fusion with additional posterior fixation. Spine 2004; 29(17): 1893–1900.

5. Crock HV. Anterior lumbar interbody fusion: indications for its use and notes on surgical techniques. Clin Orthop Relat Res 1982; 165: 157–163.

6. Kim SM, Lim TJ, Paterno J, Park J, Kim DH. Biomechanical comparison: stability of lateral-approach anterior lumbar interbody fusion and lateral fixation compared with anterior-approach anterior lumbar interbody fusion and posterior fixation in lower lumbar spine. J Neurosurg Spine 2005; 2(1): 62–68.

7. Mayer HM. A new microsurgical technique for minimally invasive anterior lumbar interbody fusion. Spine 1997; 22(6): 691–700.

8. Chen D, Fay LA, Lok J, Yuan P, Edwards WT, Yuan HA. Increasing neuroforaminal volume by anterior interbody distraction in degenerative lumbar spine. Spine 1995, 20(1): 74–79.

9. Faciszewski T, Winter RB, Lonstein JE, Denis F, Johnson L. The surgical and medical perioperative complications of anterior spinal fusion surgery in the thoracic and lumbar spine in adults. A review of 1 223 procedures. Spine 1995; 20(14):1592–1599.

10. Rajaraman V, Vingan R, Roth P, Heary RF, Conklin L,Jacobs GB. Visceral and vascular complications resulting from anterior lumbar interbody fusion. J Neurosurg 1999; 91 (Suppl 1): 60–64.

11. Dickman CA. Internal fixation and fusion of the lumbar spine using threaded interbody cages. BNI Q 1997; 13: 425.

12. Spruit M. SynCage: a titanium alloy implant for ALIF. Riv Neuroradiol 1999; 12 (Suppl 1): 115–119.

13. Spruit M, Falk RG, Beckmann L, Steffen T, Castelein RM. The in vitro stabilising effect of polyetheretherketone cages versus a titanium cage of similar design for anterior lumbar interbody fusion. Eur Spine J 2005; 14(8): 752–758.

14. Kumar A, Kozak JA, Doherty BJ, Dickson JH. Interspace distraction and graft subsidence after anterior lumbar fusion with femoral strut allograft. Spine 1993; 18(16): 2393–2400.

15. Ferguson SJ, Visser JMA, Polikeit A. The long term mechanical integrity of non reinforced PEEK-OPTIMA polymer for demanding spinal applications: experimental and finite-element analysis. Eur Spine J 2006; 15(2): 149–156.

16. Kumar N, Judith MR, Kumar A, Mishra V, Robert MC. Analysis of stress distribution in lumbar interbody fusion. Spine 2005; 30(15): 1731–1735.

17. Crock HV. Spinal instability as an iatrogenic condition and its future management. In: Szpalski M, Gunzburg R,Pope MH. Lumbar segmental instability. Philadelphia: Lippincott Williams and Wilkins 1999: 103–111.

18. Jones A, Clarke A, Freeman BJC, Lam KS, Grevitt MP. The Modic classification. Inter- and intraobserver error in clinical practice. Spine 2005; 30(16): 1867–1869.

19. Kjaer P, Leboeuf-Yde C, Korsholm L, Sorensen JS, Bendix T. Magnetic resonance imaging and low back pain in adults: A diagnostic imaging study of 40-year-old men and women. Spine 2005; 30(10): 1173–1180.

20. Vital JM, Gille O, Pointillart V, Pedram M, Bacon P,Razanabola F, Schaelderle C et al. Course of Modic 1six months after lumbar posterior osteosynthesis. Spine 2003; 28(7): 715–721.

Labels
Paediatric neurology Neurosurgery Neurology

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Czech and Slovak Neurology and Neurosurgery

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