We found a match
Your institution may have access to this item. Find your institution then sign in to continue.
- Title
Applying Pmma As Custom-Made Intervertebral Spacer Is As Safe As A Standard Peek Cage In Mono-Segmental Tlif Complications At Minimum Two-Year Follow-Up Of A Prospective Randomized Clinical Study.
- Authors
Csakany, Tibor; Puhl, Maria; Ronai, Marton; Varga, Peter Paul
- Abstract
Introduction: Although TLIF was designed to minimize the risk of injury to neural elements, there are still possible complications. Dural tear or nerve root lesion can happen while manipulating with the cage. Migration of the bone graft or spacer may result in nerve root compression, foraminal or spinal canal stenosis, etc. In a prospective randomized clinical study, we compared the radiological and clinical outcomes of mono-segmental TLIF using either a preformed commercially available PEEK cage or PMMA applied intervertebrally as a spacer. We present the complication rates of the two different methods at a minimum two-year follow-up of a prospective randomized clinical study. Material and Methods: 106 consecutive patients between 18-65 years of age, for whom a single level TLIF procedure was indicated, were included in the study. The patients were randomised into three groups by the GraphPad QuickCalcs software. Patients with a high-grade spondylolisthesis, metabolic bone disease, spinal infection, cancer, severe scoliosis (Cobb over 30°) were excluded. 8 patients were excluded 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.) Currently, the two-year follow-up ratio is 87%, 13 patients' data are not available. Group A is standard TLIF with PEEK cage positioned in the anterior part of the intervertebral space (32 patients). Group B is standard TLIF with PMMA spacer placed in the anterior part of the intervertebral space (27 patients). Group C is standard TLIF with PMMA spacer formed in the posterior part of the intervertebral space (26 patients). Operation time, blood loss, dural tears, infection rate, subsidence, implant failure, reoperation and readmission rates, length of stay in the hospital were statistically compared among the patient groups. Results: There was no significant difference in the mean operation time (A:140, B:140, C:147 min) and blood loss (A:355, B:287, C:365 ml) between the three groups. There was no infection that required surgery in any groups. There was no dural tear in any groups. There was no difference in length of hospital stay in any groups. There was one case of an immediate postoperative neurological deficit in group B. There was significant difference in subsidence (A:10, B:2, C:2; p < 0.017), and no difference in implant failure (A:5, B:5, C:1). There were 6 reoperations for reasons related to index surgery (A:2, B:3, C:1) and 7 readmissions for conservative treatment during the follow-up period (A:3, B:1, C:3). Conclusion: These results show that complication rates of using PMMA as an intervertebral spacer are not different from those of a standard PEEK cage. Intervertebral application of PMMA might be a valuable alternative to cages in certain clinical situations
- Publication
Global Spine Journal, 2018, Vol 8, p254S
- ISSN
2192-5682
- Publication type
Academic Journal
- DOI
10.1177/2192568218771072