Comparative Study Of The Effect Of Local Autologous Microparticle Bone Compression Bone Graft And PEEK Interbody Fusion Cage In Posterior Lumbar Interbody Fusion

Purposes:With the aging of the population,the number of patients with lumbar degenerative spine disease(DSD)is increasing,and the need for fusion surgery is also increasing.However,the use of autogenous bone and interbody fusion cage is still controversial.This study is to compare the clinical and imaging results of posterior lumbar interbody fusion(PLIF)with local autologous microparticle bone compression bone graft and polyether ether ketone(PEEK)interbody fusion cage in DSD,and to analyze the efficacy of PLIF in the treatment of DSD with the two fusion materials,to provide draw lessons and reference from clinical decision-making.Methods:From January 2013 to January 2019,DSD patients treated with PLIF at the Department of Orthopaedics,the Second Hospital of Lanzhou University were selected,and after screening for inclusion and exclusion criteria,the data of 168 patients were included for retrospective analysis.Among them,there were 77 cases in group A(local autologous microparticle bone compression and bone grafting group)with a total of 95 fusion segments,30 males and 47 females,with an average age of 50.5 years and an average follow-up of(18.77±13.98)months;There were 91 patients in group B(PEEK interbody fusion device group)with a total of 119 fusion segments,32 males and 59 females,with an average age of 51.8 years,and the average follow-up was(13.86±8.35)months.The pain and function of the patients were evaluated by visual analogue score(VAS),Oswestry Disability Index(ODI)and Japanese Orthopedic Association(JOA)scores before operation,three months after operation and at the last follow-up,and the improvement index and improvement rate of JOA score at the last follow-up were calculated.At the last follow-up,the clinical outcome of the patients was evaluated comprehensively by the efficacy evaluation standard of macnab,and the excellent and good rate was calculated.The height of intervertebral space and intervertebral foramen,the whole segment and segmental Cobb angle of lumbar vertebrae were measured before operation,one week after operation and at the last follow-up.The increased height of intervertebral space and intervertebral foramen one week after operation and the lost value during the last follow-up were calculated.At the last follow-up,the fusion results were evaluated according to Brantigan and Steffee criteria,and the fusion rate was calculated.SPSS 25.0 was used for statistical analysis,P<0.05 had statistical difference.Results:The operation time of group A and group B was(175.09±42.67)min and(172.79±39.65)min,respectively,and the intraoperative blood loss was(487.27±179.73)ml and(508.9±182.78)ml,respectively,with no significant difference(P>0.05).The VAS score,ODI,and JOA scores of the two groups of patients at three months after surgery and at the last follow-up were significantly improved compared with those before surgery(P<0.05);There was no significant difference in VAS score,ODI,JOA score and JOA score improvement index,improvement rate and the grade and excellent and good rate of Macnab curative effect evaluation between the two groups before operation,three months after operation and the last follow-up(P>0.05).The intervertebral space and intervertebral foramen height at one week and last follow-up were significantly higher in both groups than before surgery(P<0.05),and the overall lumbar spine and segmental Cobb angle were significantly improved compared to before surgery(P<0.05);There was no significant difference in the intervertebral space,intervertebral foramen height and Increase value between the two groups before and one week after operation(P>0.05),the height loss of group A was significantly more than that of group B at the last follow-up(P<0.05).At three time points,there was no significant difference in whole segment of lumbar vertebrae and segmental Cobb angle between the two groups(P>0.05);The fusion rates of group A and group B were 97.9% and 93.3%,respectively,with no significant difference(P=0.112),while the fusion grade of group A was significantly better than that of group B(P=0.000).The incidence of intraoperative and postoperative complications was similar between the two groups(P>0.05).Conclusion:local autologous microparticle bone compression bone graft and PEEK interbody fusion cage have shown good clinical and imaging results in PLIF of DSD.local autologous microparticle bone compression bone graft is more advantageous in promoting bone fusion,while PEEK interbody fusion cage can better maintain the intervertebral height,but the use of the latter will increase the treatment cost of patients.Therefore,the use of local autologous microparticle bone compression bone graft fusion is an effective and economical method of PLIF for DSD,especially in developing countries and less developed regions,this material is a good choice.