Clinical and radiological outcomes of posterior lumbar interbody fusion with carbon fiber cage in comparison to posterior lumbar interbody fusion with iliac bone graft

ABSTRACT

This prospective, controlled, randomized clinical study critically compared the clinical and radiological outcomes in patients surgically treated by PLIF with carbon fiber cage versus those treated by PLIF with iliac bone graft. In the period between May 2004 and April 2006, sixty patients underwent posterior interbody fusion of the lumbar spine with transpedicular screw fixation for the treatment of their degenerative segmental instability. In half of then PLIF was done using carbon fiber cage and in the other half PLIF was done using iliac bone graft. Participants were evaluated pre-operatively and post-operatively at 3, 6, 9, and 12-month intervals. Pain was scored by a VAS for both lower limb and back pain both preoperatively and postoperatively. The clinical outcomes were compared using the Prolo economic and functional rating scale and the fusion status was compared using the radiological criteria of fusion proposed by Brantigan. By 12 months follow up period, 65% of the study group expressed clinical success. Prolo scale showed clinical outcomes of patients who were treated with PLIF with carbon cage are better than those treated with PLIF with iliac crest graft but this was not statistically significant. The radiographic evaluation for bone union showed that 43% of the iliac bone group had no fusion, but 80% of cases of the cage group revealed sound fusion. Complications were matched in the 2 groups except for collapse and iliac crest harvest complications that prevail in the iliac crest group. PLIF with Carbon cage gives better fusion on radiology than PLIF with iliac bone graft, but no statistical difference in the clinical outcome. Carbon cage use precludes complications associated with iliac bone harvesting