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Journal of Peking University (Health Sciences) ›› 2023, Vol. 55 ›› Issue (5): 899-909. doi: 10.19723/j.issn.1671-167X.2023.05.019

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Efficacy analysis of autologous facet joint bone block in lumbar interbody fusion of osteoporosis patients

Da-wei WANG,Hua-dong WANG,Li LI,Xin YIN,Wei HUANG,Ji-dong GUO,Ya-feng YANG,Yi-hao LIU,Yang ZHENG*()   

  1. Department of Spine Surgery, the Fourth Medical Center, Chinese PLA General Hospital, Beijing 100048, China
  • Received:2022-11-01 Online:2023-10-18 Published:2023-10-09
  • Contact: Yang ZHENG E-mail:yangzheng@hsc.pku.edu.cn
  • Supported by:
    the National Natural Science Foundation of China(82100933)

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Abstract:

Objective: To compare and analyze the feasibility of autologous facet joint bone block as an alternative to polyetheretherketone (PEEK) cage in lumbar intervertebral fusion surgery for patients with osteoporosis. Methods: From December 2018 to June 2021, the case data of patients with osteoporosis (T value ≤ -2.5 on dual energy X-ray bone density) who underwent posterior lumbar interbody fusion in the Fourth Medical Center, Chinese PLA General Hospital were retrospectively reviewed. All the cases were followed up for no less than 12 months and were divided into two groups according to the differences of interbody fusion materials: the autologous facet joint bone block group (autogenous bone group) and the PEEK cage group (PEEK group). The general data [such as age, gender, body mass index (BMI), primary diagnosis, distribution of fusion segments, bone mineral density of lumbar (BMD), incidence of preoperative complications], the perioperative data (such as duration of operation, intraoperative blood loss, postoperative drainage, perioperative allogeneic blood transfusion rate), and the incidence of postoperative complications were compared between the two groups. Imaging parameters (disc height, lumbar lordosis angle, segment lordosis angle, segmental lordosis angle, disc height improvement rate, and fusion rate) and lumbar functional scores [visual analogue scale (VAS), Oswestry disability index (ODI), Japanese Orthopedics Association (JOA) score for lower back pain] were compared to evaluate the clinical efficacy between the kinds of intervertebral fusion materials 1 week, 3 months and 6 months postoperative and at the last follow-up. Results: A total of 118 patients were enrolled, including 68 cases in the autogenous bone group and 50 cases in the PEEK group, there were no statistical differences in age, gender, BMI, primary diagnosis, distribution of fusion segments, BMD, incidence of preoperative complications, duration of operation, intraoperative blood loss, postoperative drainage, perioperative allogeneic blood transfusion rate, incidence of postoperative complications, all the preoperative imaging parameters and all the lumbar function scores between the two groups (P>0.05). Postoperative superficial surgical site infections occurred in 3 patients in the autogenous bone group and 2 patients in the PEEK group. At the last follow-up, 3 cases of intervertebral graft collapse occurred in the autogenous bone group and 5 cases in the PEEK group, 1 case of graft subsidence in the autogenous bone group and 1 case in the PEEK group. All the imaging parameters showed significant differences between postoperation and preoperation (P < 0.05), and all the imaging parameters showed significant differences between 1 week and 3 months postoperative in both groups (P < 0.05). The height, angle of fusion gap in the autogenous bone group were lower than those in the PEEK group 1 week postoperatively (P < 0.05), and the fusion gap height improvement rate in the autogenous bone group was lower than that in the PEEK group (P < 0.05). The cases in both groups started to show final fusion 3 months after surgery, and the fusion rate in the autogenous bone group was 75% 6 months postoperatively, which was significantly higher than the rate of 56% in the PEEK group (P < 0.05), and there was no statistically significant difference in the final fusion rate between the two groups (P>0.05). The ODI, the postoperative VAS score was significantly lower than that in preoperation, while the postoperative JOA score was significantly higher than that in preoperation (P < 0.05). The ODI was lower while the JOA score was higher of the autogenous bone group than that of the PEEK group 6 months postoperatively (P < 0.05). Conclusion: In osteoporosis patients, good interbody fusion rate and improvement of lumbar vertebral function can be obtained by using autologous facet joint bone block or PEEK cage, while the fusion rate and the improvement of lumbar function with autologous facet joint bone block are better than those with PEEK cage 6 months post-operatively. PEEK cage is superior to autologous facet joint bone block in intervertebral distraction and improvement of lumbar lordosis. Significant disc space subsidence occurred in osteoporotic patients within 3 months after lumbar interbody fusion, and the subsidence of PEEK cage was more obvious than that of autologous facet joint bone block.

Key words: Spinal fusion, Autologous facet joint, Bone transplantation, Osteoporosis, Lumbar vertebrae

CLC Number: 

  • R681.5

Figure 1

Typical examples of autologous facet joint bone block before and after revision A, anterior view of a completely autologous facet joint bone block, about 22 mm long; B, lateral view of a completely autologous facet joint bone block, about 20 mm wide; C, anterior view of a trimmed autologous facet joint bone block, about 18 mm long; D, lateral view of autologous facet joint bone block, about 10 mm wide."

Figure 2

Flow chart of case screening PEEK, polyetheretherketone."

Table 1

Comparation of baseline and surgical information between the two groups"

Parameters Autogenous bone group PEEK group P value
Male 33.8% 34.0% 0.984
Age/years, ${\bar x}$±s 64.46±5.67 64.60±5.18 0.888
BMI/(kg/m2), ${\bar x}$±s 23.84±2.64 23.81±2.83 0.943
Main diagnosis(A/B/C/D) 18/31/11/8 14/23/8/5 0.991
Fusion segment(L4-L5/L5-S1) 41/27 30/20 0.974
Bone density of lumbar/(g/cm2), ${\bar x}$±s 0.78±0.11 0.76±0.12 0.939
Operation time/min, ${\bar x}$±s 126.00±12.29 127.16±10.34 0.590
Blood loss/mL, ${\bar x}$±s 221.99±49.17 223.40±54.39 0.883
Postoperative drainage/mL, ${\bar x}$±s 281.69±58.85 283.40±46.47 0.865
Allogeneic blood utilization 11.8% 14.0% 0.719
Length of hospitalization/d, ${\bar x}$±s 12.32±1.72 12.18±1.48 0.636
Follow-up time/months, ${\bar x}$±s 16.43±2.59 16.42±2.38 0.989

Table 2

Comparation of radiologic parameters between the two groups"

Parameters Preoperation 1 week postoperative 3 months postoperative 6 months postoperative Last follow-up
DH/mm, ${\bar x}$±s
    Autogenous bone group 6.83±1.63 10.29±1.53abc 10.02±1.62a 9.82±1.62a 9.72±1.61a
    PEEK group 6.81±1.48 11.01±1.48ab 10.04±1.43a 9.78±1.47a 9.69±1.43a
DH improvement rate
    Autogenous bone group 50.4% 47.1% 44.4% 44.1%
    PEEK group 61.8% 47.5% 44.1% 44.1%
DL/(°), ${\bar x}$±s
    Autogenous bone group 8.59±4.12 14.73±3.06abc 13.22±3.14a 12.74±3.14a 12.71±5.02a
    PEEK group 8.62±4.32 15.95±3.07ab 13.24±3.17a 12.25±3.26a 12.12±3.23a
SL/(°), ${\bar x}$±s
    Autogenous bone group 12.72±4.74 17.81±2.88ab 16.63±2.83a 16.32±2.93a 16.26±3.00a
    PEEK group 12.71±5.02 18.71±2.82ab 16.65±2.93a 16.04±3.05a 15.81±3.14a
LL/(°), ${\bar x}$±s
    Autogenous bone group 34.69±8.45 40.10±6.75ab 38.24±6.64a 37.39±6.40a 37.18±6.56a
    PEEK group 34.73±8.49 41.57±7.06ab 38.24±6.80a 37.36±6.60a 37.09±6.75a
Fusion rate
    Autogenous bone group 7.4% 75.0%c 94.1%
    PEEK group 6.0% 56.0% 90.0%

Figure 3

Case 1, male, 68 years old, diagnosed with lumbar disc herniation (L4-L5) and osteoporosis, underwent posterior L4-L5 modified laminectomy decompression, interbody fusion and internal fixation A and B, preoperative lumbar radiographs showed narrowing of L4-L5 intervertebral space, DH=9.5 mm, DL=10.2°, SL=14.4°, LL=33.6°; C and D, lumbar radiographs 1 week postoperative showed autologous facet joint bone block in intervertebral space, DH=12.7 mm, DL=13.2°, SL=16.7°, LL=36.1°; E and F, lumbar radiographs 15.5 months postoperative showed well intervertebral bony fusion, DH=10.4 mm, DL=11.9°, SL=14.9°, LL=32.4°; G and H, lumbar CT reconstruction image showed intervertebral bone bridge formation. DH, disc height; DL, disc lordosis; SL, segmental lordosis; LL, lumbar lordosis."

Figure 4

Case 2, female, 63 years old, diagnosed with lumbar stenosis (L4-L5) and osteoporosis, and underwent posterior L4-L5 modified laminectomy decompression, interbody fusion and internal fixation A and B, preoperative lumbar radiographs showed narrowing of L4-L5 intervertebral space, DH=9.7 mm, DL=11.5°, SL=15.4°, LL=45.2°; C and D, lumbar radiographs 1 week postoperative showed PEEK cage in intervertebral space, DH=13.3 mm, DL=15.1°, SL=18.2°, LL=51.1°; E and F, lumbar radiographs 18 months postoperative showed well intervertebral bony fusion, DH=12.7 mm, DL=14.0°, SL=16.8°, LL=48.4°; G and H, lumbar CT reconstruction image showed intervertebral bone bridge formation. DH, disc height; DL, disc lordosis; SL, segmental lordosis; LL, lumbar lordosis; PEEK, polyetheretherketone."

Table 3

Comparation of VAS score, ODI and JOA score between the two groups"

Parameters Preoperation 1 week postoperative 3 months postoperative 6 months postoperative Last follow-up
VAS score, ${\bar x}$±s
    Autogenous bone group 5.18±0.83 1.82±0.73a 1.03±0.73a 0.53±0.50a 0.41±0.49a
    PEEK group 5.18±0.87 1.82±0.66a 1.02±0.69a 0.52±0.50a 0.41±0.50a
ODI, ${\bar x}$±s
    Autogenous bone group 36.54±2.92 26.06±3.39ab 20.34±3.13ab 16.46±2.30a
    PEEK group 36.54±3.11 25.98±2.98a 21.42±2.56a 16.46±2.32a
JOA score, ${\bar x}$±s
    Autogenous bone group 12.62±1.31 20.37±1.89a 23.78±1.60ab 25.82±2.04a
    PEEK group 12.60±1.36 20.36±2.04a 22.98±1.74a 25.82±1.72a
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