The short-term clinical efficacy of trabecular titanium fusion cages in single-level lumbar fusion surgery

English Keywords:Lumbar degenerative disease  Lumbar interbody fusion  Fusion cage  Titanium alloy  Disc height

English Abstract:

  【Abstract】 Objectives: To explore the application and short-term clinical efficacy of titanium alloy trabecular interbody cage in single-level posterior lumbar decompression, bone graft fusion and internal fixation. Methods: A retrospective analysis was conducted on 68 patients undergone single-level posterior lumbar decompression, bone graft fusion and internal fixation between June 2022 and June 2023 at the Department of Orthopaedics, Shanghai Xuhui District Central Hospital. 32 patients received the titanium alloy trabecular cage were included into the titanium group, which consisted of 12 males and 20 females, aged 60.9±10.4 years, and 12 were diagnosed with osteoporosis; Fusion levels: L3/4 in 2, L4/5 in 27, L5/S1 in 3. 36 patients received the polyetheretherketone(PEEK) cage were included into the PEEK group, and there were 10 males and 26 females, aged 62.9±9.1 years, among them 12 were diagnosed with osteoporosis; Fusion levels: L3/4 in 2, L4/5 in 29, L5/S1 in 5. The patients were followed up for 24-30months(26.8±1.8 months). Preoperative, postoperative, and final follow-up visual analog scale(VAS) scores and Oswestry disability index(ODI) were recorded. Operative time, intraoperative blood loss, postoperative drainage, hospital stay, and complications after operation till the final follow-up were compared. Radiographic parameters, including lumbar lordosis(LL), disc height(DH), incidence of cage subsidence, and interbody fusion rate, were assessed to evaluate the improvement and maintenance of LL and DH. Results: All surgeries were completed successfully. There were no significant differences between the two groups in operative time, blood loss, postoperative drainage, and hospital stay(P>0.05). In the titanium group, the VAS scores were 6.88±1.07 preoperatively, 3.31±0.97 postoperatively, and 1.06±0.80 at final follow-up; DH values were 8.74±2.42mm, 12.17±1.38mm, and 11.63±1.27mm, respectively; LL values were 40.47°±15.10°, 38.34°±10.49°, and 39.86°±12.53°, respectively. In the PEEK group, the VAS scores were 6.83±1.05, 3.08±0.81, and 0.92±0.84; DH values were 8.57±2.30mm, 11.17±1.28mm, and 9.76±1.15mm; LL values were 47.10°±14.26°, 42.46°±13.02°, and 39.33°±13.39°, respectively. ODI improved from 40.67±6.06 preoperatively to 19.46±2.31 at final follow-up in titanium group, and from 37.95±5.19 to 18.90±3.29 in the PEEK group. Both groups showed significant improvements in VAS scores and ODI at postoperative immediately and final follow-up compared with baseline(P<0.05), with no inter-group differences at the corresponding time points(P>0.05). Postoperative DH was significantly increased compared with preoperative values in both groups(P<0.05). At final follow-up, the losses of LL and DH, as well as the cage subsidence rate were significantly lower in the titanium group than in the PEEK group(P<0.05). The fusion rate was 100% in the titanium group and 91.7%(33/36) in the PEEK group, with no statistical difference(P>0.05); Patients with incomplete fusion had no significant low back pain. No implant breakage, loosening, or migration occurred in either group during follow-up. Conclusions: Compared with PEEK cage, the titanium alloy trabecular interbody cage can yield a favorable fusion effect in single-level lumbar fusion surgery, restore and maintain LL and DH. It has a good anti-subsidence property and can reduce the magnitude of DH loss.