Influence of facetectomy, cross-link augmentation, and interbody procedure on progression of bone fusion in single-level posterior lumbar interbody fusion using the long cortical bone trajectory technique.

Abstract

Objective: When using the cortical bone trajectory (CBT) technique, two technical countermeasures are recommended to promote bone fusion: taking a long CBT screw path directed more anteriorly and improving the stability of the spinal construct by facet joint preservation, cross-link augmentation, and rigid anterior interbody reconstruction. However, there has been no report on how these surgical procedures, which are heavily dependent on the surgeon's preference, contribute to successful bone fusion. The aim of the present study was to investigate the progression of lumbar spinal fusion using the long CBT technique and identify factors contributing to the time taken to achieve bone fusion, with a particular focus on the involvement of surgical procedures.

Methods: A total of 167 consecutive patients with L4 degenerative spondylolisthesis who underwent single-level posterior lumbar interbody fusion at L4-5 using the long CBT technique were included (mean follow-up 42.8 months). Bone fusion was assessed to identify factors contributing to the time to achieve bone fusion. Investigated factors were 1) age, 2) sex, 3) BMI, 4) bone mineral density, 5) intervertebral mobility, 6) screw depth in the vertebra, 7) extent of facetectomy, 8) cross-link augmentation, 9) cage material, 10) cage design, 11) number of cages, and 12) contact area of cages with the vertebral endplate.

Results: The bone fusion rate was 89.2% at 2 years postoperatively and 95.8% at the last follow-up, with a mean period to bone fusion of 16.6 ± 9.6 months. Multivariate regression analysis revealed that age (standardized regression coefficient [β] = 0.25, p = 0.002), female sex (β = -0.22, p = 0.004), and BMI (β = 0.15, p = 0.045) were significant independent factors affecting the time to achieve bone fusion. There was no significant effect of surgical procedures (p ≥ 0.364).

Conclusions: This is the first study to investigate the progression of lumbar spinal fusion using the long CBT technique and identify factors contributing to the time taken to achieve bone fusion. Patient factors such as age, sex, and BMI affected the progression of bone fusion, and surgical factors had only weak effects.