Effectiveness of nano-hydroxyapatite/polyamide-66 Cage in interbody fusion for degenerative lumbar scoliosis_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

HU Jianyu ,  OU Yunsheng , ZHU Yong , LUO Wei , ZHAO Zenghui , DU Xing , LI Jianxiao

Department of Orthopedics, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, P.R.China;

Corresponding?author：

OU Yunsheng, Email: ouyunsheng2001@163.com

Keywords：

Degenerative lumbar scoliosis; interbody fusion; nano-hydroxyapatite; polyamide-66; Cage

DOI：

10.7507/1002-1892.201807060

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To explore the effectiveness of nano-hydroxyapatite/polyamide-66 (n-HA/PA66) Cage in interbody fusion for degenerative lumbar scoliosis.Methods A retrospective analysis was designed and conducted for 43 patients, who underwent posterior decompression and n-HA/PA66 Cage interbody fusion with correction of deformity between January 2013 and June 2016. Eighteen cases were single-level fusion (single-level group) and 25 cases were double-level fusion (double-level group). There was no significant difference in gender, age, body mass index, direction of convex, degree of apical rotation, fusion level, the number of osteoporotic patients, pre-operative intervertebral height of fusion segments, coronal Cobb angle, visual analogue score (VAS), and modified Oswestry Disability Index (ODI) between 2 groups (P>0.05). The operation time, intraoperative blood loss, postoperative drainage, hospital stay, and complications of the operation were recorded. Modified ODI, VAS score, and MacNab criteria were adopted to assess clinical outcomes. Radiographic indexes, including intervertebral height of fusion segments, coronal Cobb angle, disc insertion depth, and the bone graft fusion rate, were also evaluated.Results There was no significant difference in operation time, intraoperative blood loss, postoperative drainage, and hospital stay between 2 groups (P>0.05). All patients were followed up 18-62 months (mean, 30.9 months). Wound complications, postoperative delirium, and Cage retropulsion occurred in 4 cases (2 cases in single-level group, 2 cases in double-level group), 1 case of single-level group, and 1 case of double-level group, respectively. The intervertebral height of fusion segments after operation significantly improved compared with preoperative ones in both groups (P<0.05). At last follow-up, the intervertebral height in double-level group was superior to which in single-level group (P<0.05). The coronal Cobb angles after operation significantly improved compared with preoperative ones (P<0.05), and no significant difference was found between 2 groups at each time point (P>0.05). The disc insertion depth showed no significant difference between different time points after operation in 2 groups (P>0.05) and between 2 groups at each time point after operation (P>0.05). Bony fusion was obtained in all patients at last follow-up. The VAS score and modified ODI after operation in both groups were superior to those before operation (P<0.05). The VAS score in double-level group was higher than that in single-level group (P<0.05) at last follow-up, and no significant difference was found in VAS score and modified ODI between 2 groups at other time points (P>0.05). According to the MacNab criteria, the excellent and good rates at last follow-up were 94.4% and 84.0% in single-level group and double-level group, respectively.Conclusion The n-HA/PA66 Cage can effectively restore and maintain the disc height of fusion segment, normal sequence, and biomechanical stability of the spine, and gain favorable effectivenss for degenerative lumbar scoliosis. And double-level fusion is superior to single-level fusion in maintaining disc height of fusion segment.

Citation： HU Jianyu, OU Yunsheng, ZHU Yong, LUO Wei, ZHAO Zenghui, DU Xing, LI Jianxiao. Effectiveness of nano-hydroxyapatite/polyamide-66 Cage in interbody fusion for degenerative lumbar scoliosis. Chinese Journal of Reparative and Reconstructive Surgery, 2019, 33(3): 287-295. doi: 10.7507/1002-1892.201807060 Copy

1.	York PJ, Kim HJ. Degenerative scoliosis. Curr Rev Musculoskelet Med, 2017, 10(4): 547-558.
2.	Tsutsui S, Yoshimura N, Watanuki A, et al. Risk factors and natural history of de novo degenerative lumbar scoliosis in a community-based cohort: the miyama study. Spine Deform, 2013, 1(4): 287-292.
3.	Swamy G, Lopatina E, Thomas KC, et al. The cost effectiveness of minimally invasive spine surgery in the treatment of adult degenerative scoliosis: A comparison of transpsoas and open techniques. Spine J, 2019, 19(2): 339-348.
4.	Brantigan JW, Steffee AD. A carbon fiber implant to aid interbody lumbar fusion. Two-year clinical results in the first 26 patients. Spine (Phila Pa 1976), 1993, 18(14): 2106-2107.
5.	Ailon T, Smith JS, Shaffrey CI, et al. Degenerative spinal deformity. Neurosurgery, 2015, 77(Suppl 4): S75-S91.
6.	Cho KJ, Kim YT, Shin SH, et al. Surgical treatment of adult degenerative scoliosis. Asian Spine J, 2014, 8(3): 371-381.
7.	張志成, 任大江, 孫天勝, 等. 退變性腰椎側凸合并椎管狹窄的階梯性治療策略. 中國修復重建外科雜志, 2011, 25(8): 951-955.
8.	Kuslich SD, Bagby G. The BAK interbody fusion system: early clinical results of treatment for chronic low back pain. The 8th Annual Meeting of the North American Spine Society. San Diego: [s.n], 1993.
9.	王松, 楊函, 楊劍, 等. 多孔磷酸鈣/骨基質明膠復合骨水泥修復兔腰椎骨缺損的實驗研究. 中國修復重建外科雜志, 2017, 31(12): 1462-1467.
10.	Seaman S, Kerezoudis P, Bydon M, et al. Titanium vs. polyetheretherketone (PEEK) interbody fusion: Meta-analysis and review of the literature. J Clin Neurosci, 2017, 44: 23-29.
11.	郜德龍, 方忠, 孫允龍, 等. 同種異體骨 Cage 在經椎間孔腰椎椎間融合手術中的應用. 中國修復重建外科雜志, 2018, 32(7): 927-932.
12.	趙勃然, 鄭修軍, 馬金榮. 椎間融合器及其材料的研究與進展. 中國組織工程研究, 2017, 21(2): 315-321.
13.	Xiong Y, Ren C, Zhang B, et al. Analyzing the behavior of a porous nano-hydroxyapatite/polyamide 66 (n-HA/PA66) composite for healing of bone defects. Int J Nanomedicine, 2014, 9: 485-494.
14.	溫從游, 孟純陽, 蔣電明. 納米羥基磷灰石/聚酰胺 66 復合材料的研究及應用. 中國組織工程研究, 2014, 18(3): 464-469.
15.	楊曦, 宋躍明, 孔清泉, 等. 納米羥基磷灰石/聚酰胺 66 椎間融合器植骨融合治療下腰椎退變性疾病的近期療效. 中國修復重建外科雜志, 2012, 26(12): 1425-1429.
16.	鄧乾興, 歐云生, 蔣電明, 等. n-HA/PA66 椎間融合器在頸椎病前路椎間盤切除減壓融合術的中期臨床療效. 重慶醫科大學學報, 2016, 41(5): 489-494.
17.	Deng QX, Ou YS, Zhu Y, et al. Clinical outcomes of two types of cages used in transforaminal lumbar interbody fusion for the treatment of degenerative lumbar diseases: n-HA/PA66 cages versus PEEK cages. J Mater Sci Mater Med, 2016, 27(6): 102.
18.	Cinotti G, De Santis P, Nofroni I, et al. Stenosis of lumbar intervertebral foramen: anatomic study on predisposing factors. Spine (Phila Pa 1976), 2002, 27(3): 223-229.
19.	Hueng DY, Chung TT, Chuang WH, et al. Biomechanical effects of cage positions and facet fixation on initial stability of the anterior lumbar interbody fusion motion segment. Spine (Phila Pa 1976), 2014, 39(13): E770-E776.
20.	Kurra S, Lavelle WF, Silverstein MP, et al. Long-term outcomes of transforaminal lumbar interbody fusion in patients with spinal stenosis and degenerative scoliosis. Spine J, 2018, 18(6): 1014-1021.
21.	Landham PR, Don AS, Robertson PA. Do position and size matter? An analysis of cage and placement variables for optimum lordosis in PLIF reconstruction. Eur Spine J, 2017, 26(11): 2843-2850.
22.	鄧乾興, 歐云生, 朱勇, 等. 經椎間孔單節段腰椎椎間融合術后融合器下沉的危險因素分析. 中華骨科雜志, 2018, 38(3): 156-163.
23.	Aoki Y, Yamagata M, Nakajima F, et al. Examining risk factors for posterior migration of fusion cages following transforaminal lumbar interbody fusion: a possible limitation of unilateral pedicle screw fixation. J Neurosurg Spine, 2010, 13(3): 381-387.
24.	Khajavi K, Shen AY. Two-year radiographic and clinical outcomes of a minimally invasive, lateral, transpsoas approach for anterior lumbar interbody fusion in the treatment of adult degenerative scoliosis. Eur Spine J, 2014, 23(6): 1215-1223.
25.	孟純陽, 安洪, 蔣電明. 新型納米骨關節修復重建材料的生物活性及近期對機體鈣磷代謝的影響. 中國骨與關節損傷雜志, 2005, 20(10): 682-684.
26.	Pan FM, Wang SJ, Yong ZY, et al. Risk factors for cage retropulsion after lumbar interbody fusion surgery: Series of cases and literature review. Int J Surg, 2016, 30: 56-62.
27.	馬龍冰, 賈云兵, 宋躍明, 等. 聚氨基酸/納米羥基磷灰石/硫酸鈣椎間融合器在腰椎融合術中的初步應用. 中國修復重建外科雜志, 2016, 30(3): 328-335.
28.	Abbushi A, Cabraja M, Thomale UW, et al. 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. Eur Spine J, 2009, 18(11): 1621-1628.
29.	Wang L, Zhang B, Chen S, et al. A validated finite element analysis of facet joint stress in degenerative lumbar scoliosis. World Neurosurg, 2016, 95: 126-133.
30.	Zhang XN, Sun XY, Meng XL, et al. Risk factors for medical complications after long-level internal fixation in the treatment of adult degenerative scoliosis. Int Orthop, 2018, 42(11): 2603-2612.

1. York PJ, Kim HJ. Degenerative scoliosis. Curr Rev Musculoskelet Med, 2017, 10(4): 547-558.
2. Tsutsui S, Yoshimura N, Watanuki A, et al. Risk factors and natural history of de novo degenerative lumbar scoliosis in a community-based cohort: the miyama study. Spine Deform, 2013, 1(4): 287-292.
3. Swamy G, Lopatina E, Thomas KC, et al. The cost effectiveness of minimally invasive spine surgery in the treatment of adult degenerative scoliosis: A comparison of transpsoas and open techniques. Spine J, 2019, 19(2): 339-348.
4. Brantigan JW, Steffee AD. A carbon fiber implant to aid interbody lumbar fusion. Two-year clinical results in the first 26 patients. Spine (Phila Pa 1976), 1993, 18(14): 2106-2107.
5. Ailon T, Smith JS, Shaffrey CI, et al. Degenerative spinal deformity. Neurosurgery, 2015, 77(Suppl 4): S75-S91.
6. Cho KJ, Kim YT, Shin SH, et al. Surgical treatment of adult degenerative scoliosis. Asian Spine J, 2014, 8(3): 371-381.
7. 張志成, 任大江, 孫天勝, 等. 退變性腰椎側凸合并椎管狹窄的階梯性治療策略. 中國修復重建外科雜志, 2011, 25(8): 951-955.
8. Kuslich SD, Bagby G. The BAK interbody fusion system: early clinical results of treatment for chronic low back pain. The 8th Annual Meeting of the North American Spine Society. San Diego: [s.n], 1993.
9. 王松, 楊函, 楊劍, 等. 多孔磷酸鈣/骨基質明膠復合骨水泥修復兔腰椎骨缺損的實驗研究. 中國修復重建外科雜志, 2017, 31(12): 1462-1467.
10. Seaman S, Kerezoudis P, Bydon M, et al. Titanium vs. polyetheretherketone (PEEK) interbody fusion: Meta-analysis and review of the literature. J Clin Neurosci, 2017, 44: 23-29.
11. 郜德龍, 方忠, 孫允龍, 等. 同種異體骨 Cage 在經椎間孔腰椎椎間融合手術中的應用. 中國修復重建外科雜志, 2018, 32(7): 927-932.
12. 趙勃然, 鄭修軍, 馬金榮. 椎間融合器及其材料的研究與進展. 中國組織工程研究, 2017, 21(2): 315-321.
13. Xiong Y, Ren C, Zhang B, et al. Analyzing the behavior of a porous nano-hydroxyapatite/polyamide 66 (n-HA/PA66) composite for healing of bone defects. Int J Nanomedicine, 2014, 9: 485-494.
14. 溫從游, 孟純陽, 蔣電明. 納米羥基磷灰石/聚酰胺 66 復合材料的研究及應用. 中國組織工程研究, 2014, 18(3): 464-469.
15. 楊曦, 宋躍明, 孔清泉, 等. 納米羥基磷灰石/聚酰胺 66 椎間融合器植骨融合治療下腰椎退變性疾病的近期療效. 中國修復重建外科雜志, 2012, 26(12): 1425-1429.
16. 鄧乾興, 歐云生, 蔣電明, 等. n-HA/PA66 椎間融合器在頸椎病前路椎間盤切除減壓融合術的中期臨床療效. 重慶醫科大學學報, 2016, 41(5): 489-494.
17. Deng QX, Ou YS, Zhu Y, et al. Clinical outcomes of two types of cages used in transforaminal lumbar interbody fusion for the treatment of degenerative lumbar diseases: n-HA/PA66 cages versus PEEK cages. J Mater Sci Mater Med, 2016, 27(6): 102.
18. Cinotti G, De Santis P, Nofroni I, et al. Stenosis of lumbar intervertebral foramen: anatomic study on predisposing factors. Spine (Phila Pa 1976), 2002, 27(3): 223-229.
19. Hueng DY, Chung TT, Chuang WH, et al. Biomechanical effects of cage positions and facet fixation on initial stability of the anterior lumbar interbody fusion motion segment. Spine (Phila Pa 1976), 2014, 39(13): E770-E776.
20. Kurra S, Lavelle WF, Silverstein MP, et al. Long-term outcomes of transforaminal lumbar interbody fusion in patients with spinal stenosis and degenerative scoliosis. Spine J, 2018, 18(6): 1014-1021.
21. Landham PR, Don AS, Robertson PA. Do position and size matter? An analysis of cage and placement variables for optimum lordosis in PLIF reconstruction. Eur Spine J, 2017, 26(11): 2843-2850.
22. 鄧乾興, 歐云生, 朱勇, 等. 經椎間孔單節段腰椎椎間融合術后融合器下沉的危險因素分析. 中華骨科雜志, 2018, 38(3): 156-163.
23. Aoki Y, Yamagata M, Nakajima F, et al. Examining risk factors for posterior migration of fusion cages following transforaminal lumbar interbody fusion: a possible limitation of unilateral pedicle screw fixation. J Neurosurg Spine, 2010, 13(3): 381-387.
24. Khajavi K, Shen AY. Two-year radiographic and clinical outcomes of a minimally invasive, lateral, transpsoas approach for anterior lumbar interbody fusion in the treatment of adult degenerative scoliosis. Eur Spine J, 2014, 23(6): 1215-1223.
25. 孟純陽, 安洪, 蔣電明. 新型納米骨關節修復重建材料的生物活性及近期對機體鈣磷代謝的影響. 中國骨與關節損傷雜志, 2005, 20(10): 682-684.
26. Pan FM, Wang SJ, Yong ZY, et al. Risk factors for cage retropulsion after lumbar interbody fusion surgery: Series of cases and literature review. Int J Surg, 2016, 30: 56-62.
27. 馬龍冰, 賈云兵, 宋躍明, 等. 聚氨基酸/納米羥基磷灰石/硫酸鈣椎間融合器在腰椎融合術中的初步應用. 中國修復重建外科雜志, 2016, 30(3): 328-335.
28. Abbushi A, Cabraja M, Thomale UW, et al. 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. Eur Spine J, 2009, 18(11): 1621-1628.
29. Wang L, Zhang B, Chen S, et al. A validated finite element analysis of facet joint stress in degenerative lumbar scoliosis. World Neurosurg, 2016, 95: 126-133.
30. Zhang XN, Sun XY, Meng XL, et al. Risk factors for medical complications after long-level internal fixation in the treatment of adult degenerative scoliosis. Int Orthop, 2018, 42(11): 2603-2612.

Chinese Journal of Reparative and Reconstructive Surgery

Effectiveness of nano-hydroxyapatite/polyamide-66 Cage in interbody fusion for degenerative lumbar scoliosis

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content