We found a match
Your institution may have access to this item. Find your institution then sign in to continue.
- Title
Custom Made Pmma Spacer Performs Better in Single Level Tlif Than Preformed Peek Spacer. Minimum Two Years Follow Up of a Prospective Randomized Study.
- Authors
Ronai, Marton; Csakany, Tibor; Puhl, Maria; Varga, Peter Pal
- Abstract
Introduction: The use of bone cement in spine surgery is more and more accepted world-wide not only for performing vertebro- or kyphoplasty, but also to fill open or percutaneosly the intervertebral space in advanced disc degeneration to stabilize the anterior column. In our Institut we also use PMMA as a spacer in TLIF procedures. In a previous retrospective analysis we reviewed are results with this kind of surgeries which led us to start a prospective randomized study. Here we present our results at a minimum of two years follow up. Material and Methods: 106 consecutive patients to whom we suggested to perform single level TLIF were included into the study. The patients were randomised into three groups by the GraphPad QuickCalcs software. Group A is a control group, standard TLIF with PEEK spacer positioned in the anterior part of the intervertebral space. Group B is standard TLIF with PMMA spacer placed in the anterior part of the intervertebral space. Group C is standard TLIF with PMMA spacer formed in the posterior part of the intervertebral space. Patients between 18- 65 y/o were included. Patients with a high grade spondylolisthesis, metabolic bone desease, spinal infection, cancer, severe scoliosis (Cobb over 30°) were excluded. We evaluated the clinical results with standard questioners (ODI, VAS). Radiological evaluation was focused on the process of bony fusion, loosening of any instrument implanted (PMMA spacer or screws), osteolysis around the cement, subsidence. Results: 8 patients were excluded from the cohort, because the operating surgeon did not follow the randomization for some surgical reason (i.e. not enough place for a spacer, injury of the end plate, etc.). At this moment 5 of the 98 followed patients (4,9%) are lost from the study (did not come to the planned control) 93 patinets (94,9%) have at least 12 month follow up, and 85 completed the 24 month follow up (86,7%). From this 85 subjects, 32 are in Group A, 27 in Group B, and 26 in Group C. On CT scan 12 months after surgery we could observe complete fusion in 74% of the operated segments and the fusion rate was higher in the PMMA spacer group B, but the difference was not significant. The overall fusion rate at 24 months is 93%, and there was no difference between the groups. We found 14 subsidence (13%), 10 in the PEEK spacer group (A) meaning, that the subsidence rate was significantly higher in this group. We found a radiolucent zone around the implant (sign of loosening) in only 7 cases (6,6%), 5 in the A group, 1 in the B group and 1 in the C group. This difference was not significant. The overall clinical result was very good in 61%, good in 28% and poor in 11% of the cases without significant difference between the groups. Conclusion: This results show, that custom made PMMA spacer in TLIF performs better regarding the mechanical aim of the surgery than preformed PEEK spacer even in non-osteoporotic population. The clinical result is not inferior either, than with the use of PEEK spacer, but this technic has some advantages compared to preformed cages: it is cheaper; it requires smaller annular window to implant.
- Publication
Global Spine Journal, 2018, Vol 8, p87S
- ISSN
2192-5682
- Publication type
Academic Journal
- DOI
10.1177/2192568218771030