Endplate Changes with Polyetheretherketone Cages in Posterior Lumbar Interbody Fusion

Abstract

Study Design: A retrospective radiographic analysis.Purpose: The aim of the current study is to assess endplate changes after the use of polyetheretherketone (PEEK) cages in posterior lumbar interbody fusion (PLIF).Overview of Literature: A few recent reports had revealed endplate abnormalities due to PEEK cages, which may lead to nonunions.Methods: A retrospective computed tomography (CT)-based analysis of the endplate cavities and fusion status following PLIFs with PEEK cages was conducted by two independent observers. The term “cavity” was used to describe the endplate changes. The vertebral endplate cavities were assessed according to the size, multiplicity, location, and presence or absence of sclerosis.Results: There were 86 fixed levels in 65 consecutive patients, with a mean age of 35.44±19.60 years. The mean follow-up was 16.5±10.1 months (range, 6–57 months). Definite fusion was seen in 56 levels (65.12%) by observer 1 versus 44 levels (51.16) by observer 2. The strength of agreement was moderate. Endplate cavities were observed in 42 levels (48.84%) by observer 1 versus 47 levels (54.65%) by observer 2, with fair agreement. The strengths of agreement for the locations, multiplicity, and size were moderate, fair, and poor, respectively. Neither age, sex, etiology, levels, nor follow-up period was significantly associated with the presence of cavities. With regard to fusions, the nonunions detected by observer 1 were significantly associated with the presence of cavities (p<0.0001). However, those detected by observer 2 were nearly significant (p=0.05).Conclusions: There was a high rate of unfavorable radiographic findings in the form of endplate cavities in PLIF cases with PEEK cages. A more comprehensive classification for the assessment of fusions and endplate cavities should be formulated. We strongly recommend further CT-based studies with larger sample size and longer follow-up periods.

Clinical and radiological outcomes in patients who underwent posterior lumbar interbody fusion: comparisons between unilateral and bilateral cage insertion

“…Posterior lumbar interbody fusion (PLIF) is a well-proven procedure to perform in patients who require stabilization following wide decompression for spinal stenosis or spondylolisthesis [1,2]. PLIF involves cage insertion through the disc space.…”

Novel Surgical Technique for Adolescent Idiopathic Scoliosis: Minimally Invasive Scoliosis Surgery

“…Although autologous bone is considered the gold standard bone graft material, it is well known to be associated with several graft site morbidities, such as pain, hematoma formation, infection, and pelvic fracture [ 22 , 23 ]. BMP has been widely utilized to increase fusion potential in various spinal fusion surgeries [ 24 , 25 ]. Although several previous studies have reported no significant difference in acute complications and malignancy risk between pediatric patients treated with and without BMP, complications such as wound infections, seromas, and heterotopic bone development have also been reported [ 26 , 27 , 28 , 29 , 30 ].…”

Evaluation of the efficacy and safety of Escherichia coli-derived recombinant human bone morphogenetic protein-2 in transforaminal lumbar interbody fusion to treat degenerative spinal disease: a protocol of prospective, randomized controlled, assessor-blinded, open-label, multicenter trial

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