Comparative study of posterior lumbar interbody fusion by strut laminar autograft versus cage in degenerative lumbar spine diseases

Abstract

Degenerative spondylolisthesis and lumbar disk degeneration are common degenerative diseases of the spine that may lead to lower back pain and radicular leg pain. The perfect surgical treatment remains a point of debate; interbody fusion has been recognized as having a ‘golden role’ in the treatment of lumbar degenerative diseases, but spinal interbody fusion with polyetheretherketone (PEEK) cage surgery often incurs numerous complications such as cage retropulsion, nonunion, and high cost. We hypothesize that the autologous strut laminar graft will show clinical and radiological results similar to those obtained using a PEEK cage. To compare the primary outcome (clinical pain relief) and the secondary outcome (radiological signs of union and rate of fusion) when using strut laminar graft versus PEEK cage in posterior lumbar interbody fusion (PLIF) technique in the surgical management of degenerative lumbar diseases. Forty patients with single-level lumbar degenerative disk disease and/or degenerative spondylolisthesis grades 1 or 2 underwent PLIF surgery between November 2017 and December 2020. All patients were randomly divided into two groups according to the method of fusion (group A: laminar strut graft and group B: PEEK cage). Single-level PLIF was performed in all patients. Clinical, radiological, functional, and perioperative data were recorded and compared. The mean follow-up was 22 ± 6 months. Clinical improvement and radiological fusion were significantly documented in each group (P>0.05). However, no significant difference existed between the two groups regarding demographic, radiological, and functional outcomes. The results suggest that the laminar strut graft when used instead of the cage seems to be an equally safe and low-priced method of interbody fusion.