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. 2009 Nov;18(11):1621-8.
doi: 10.1007/s00586-009-1036-3. Epub 2009 May 28.

The influence of cage positioning and cage type on cage migration and fusion rates in patients with monosegmental posterior lumbar interbody fusion and posterior fixation

Alexander Abbushi  1 , Mario Cabraja, Ulrich-Wilhelm Thomale, Christian Woiciechowsky, Stefan Nikolaus Kroppenstedt
Affiliations

The influence of cage positioning and cage type on cage migration and fusion rates in patients with monosegmental posterior lumbar interbody fusion and posterior fixation

Alexander Abbushi et al. Eur Spine J. 2009 Nov.

Abstract

In posterior lumbar interbody fusion, cage migrations and lower fusion rates compared to autologous bone graft used in the anterior lumbar interbody fusion procedure are documented. Anatomical and biomechanical data have shown that the cage positioning and cage type seem to play an important role. Therefore, the aim of the present study was to evaluate the impact of cage positioning and cage type on cage migration and fusion. We created a grid system for the endplates to analyze different cage positions. To analyze the influence of the cage type, we compared "closed" box titanium cages with "open" box titanium cages. This study included 40 patients with 80 implanted cages. After pedicle screw fixation, 23 patients were treated with a "closed box" cage and 17 patients with an "open box" cage. The follow-up period averaged 25 months. Twenty cages (25%) showed a migration into one vertebral endplate of <3 mm and four cages (5%) showed a migration of > or =3 mm. Cage migration was highest in the medio-medial position (84.6%), followed by the postero-lateral (42.9%), and the postero-medial (16%) cage position. Closed box cages had a significantly higher migration rate than open box cages, but fusion rates did not differ. In conclusion, cage positioning and cage type influence cage migration. The medio-medial cage position showed the highest migration rate. Regarding the cage type, open box cages seem to be associated with lower migration rates compared to closed box cages. However, the cage type did not influence bone fusion.

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Figures

Fig. 1
Fig. 1
Left ProSpace cage manufactured by Aesculap, coated with a plasmapore surface with an electro-microscopic picture of the plasmapore surface. Right OIC titanium cage manufactured by Stryker
Fig. 2
Fig. 2
Left grid system in which the endplate was divided into four parts in the lateral and antero-posterior plain. Six cage fields/positions (postero-lateral, medio-lateral, antero-lateral, postero-medial, medio-medial or antero-medial) are possible on each side, since one cage fills two blocks. Right CT scan with overlying grid system showing two cages in a medio-medial location, as classified by the grid system
Fig. 3
Fig. 3
Lateral X-ray of a non-migrated OIC cage (left). CT scan in sagittal view of a migrated (subsided) Prospace cage (right)
See this image and copyright information in PMC

References

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