Wan Zongmiao, Dai Min, Miao Jun, Li Guoan, Wood Kirkham B
*Department of Orthopedics, First Affiliated Hospital of Nanchang University, Nanchang, China †Department of Orthopaedics, Massachusetts General Hospital and Harvard Medical School, Boston, MA.
J Spinal Disord Tech. 2014 Aug;27(6):327-35. doi: 10.1097/BSD.0b013e31825f2674.
Retrospective radiographic study.
To radiographically evaluate sagittal plane profile and fusion rates of polyetheretherketone (PEEK) cages versus femoral ring allografts (FRAs) in patients with adult spinal deformity fused to the sacrum.
FRAs have been widely used in various degenerative lumbar spine disorders and in adult deformity to achieve interbody fusions with promising results. PEEK cages have gained increasing popularity of late; however, there is little documentation to the radiographic comparisons between PEEK cages and FRAs used in patients with adult spine deformity treated with long fusions to the sacrum.
From March 2006 to February 2010, we analyzed 48 patients (mean age, 56.3±13.9 y) of 61 consecutive adult patients with global coronal and sagittal adult spine deformities who underwent first stage ALIF using PEEK cages or FRAs at L4-L5, L5-S1 segments followed by long (>6 levels) posterior instrumentation. PEEK cages and FRAs were used randomly according to surgeon's preference. Two independent observers retrospectively evaluated preoperative and postoperative disk height, foraminal height, segmental lordosis, and the interbody fusion rates at different postoperative intervals.
Both PEEK cages and FRAs significantly (P<0.05) maintained disk space height at all follow-up times. PEEK cages maintained foraminal height and segmental lordosis, especially at L4-L5 better than FRAs at the final follow-up. At the final follow-up, PEEK cages achieved 94.9% of fusion rate, which was significantly (P<0.05) superior to FRA (84.2%), and PEEK cages were superior to FRAs in attaining earlier solid fusion. The Prolo functional scores of FRAs or/and PEEK cages were significantly improved at the final follow-up and did not show a significant difference between them.
Both PEEK cages and FRAs can significantly increase disk space height and achieve similar clinical outcomes in treating adult spinal deformity fused to the sacrum. The radiographic results of PEEK cages were superior to FRAs in terms of an earlier solid fusion, and greater restoration of segmental lordosis.
回顾性影像学研究。
通过影像学评估聚醚醚酮（PEEK）椎间融合器与同种异体股骨环（FRA）在成人脊柱畸形融合至骶骨患者矢状面形态及融合率方面的情况。
FRA已广泛应用于各种退行性腰椎疾病及成人脊柱畸形以实现椎间融合，效果良好。PEEK椎间融合器近年来越来越受欢迎；然而，关于在成人脊柱畸形患者中使用PEEK椎间融合器与FRA并进行长节段融合至骶骨治疗后的影像学比较的文献报道较少。
2006年3月至2010年2月，我们分析了61例连续的成人脊柱冠状面和矢状面畸形患者中的48例（平均年龄56.3±13.9岁），这些患者在L4-L5、L5-S1节段接受了一期前路腰椎椎间融合术（ALIF），使用PEEK椎间融合器或FRA，随后进行长节段（>6个节段）后路内固定。PEEK椎间融合器和FRA根据外科医生的偏好随机使用。两名独立观察者回顾性评估术前和术后不同时间间隔的椎间盘高度、椎间孔高度、节段性前凸以及椎间融合率。
在所有随访时间，PEEK椎间融合器和FRA均显著（P<0.05）维持了椎间盘间隙高度。在末次随访时，PEEK椎间融合器在维持椎间孔高度和节段性前凸方面，尤其是在L4-L5节段，优于FRA。在末次随访时，PEEK椎间融合器的融合率达到94.9%，显著（P<0.05）高于FRA（84.2%），并且PEEK椎间融合器在更早实现坚固融合方面优于FRA。在末次随访时，FRA或/和PEEK椎间融合器的Prolo功能评分均显著改善，且两者之间无显著差异。
PEEK椎间融合器和FRA在治疗成人脊柱畸形融合至骶骨时均能显著增加椎间盘间隙高度并取得相似的临床效果。在更早实现坚固融合以及更好地恢复节段性前凸方面，PEEK椎间融合器的影像学结果优于FRA。
