101 PLIF trussed with a titanium intersomatic parallelepipedic cage and a posterior instrumentation
Daniel Gastambide,
MD, Orth. Surg. (Centre Tourville, Paris)
The purpose of this paper is the study of 101 PLIF with the technique, results and discussion of indications.
Materiel and methods
The indications were chronic hyperalgic invalidating lombosciaticas, resisting at least 6 months to all non invasive therapeutics, or failure of the previous surgical treatments.
The PLIF is trussed with a hollow titanium intersomatic parallelepipedic cage, filled with laminar bone fragments, and with instrumented pedicular screwed implants and plates. Patients mean age is 45. There are 54 males and 47 females. Mean lumbalgia duration before surgery is 5 years. There are 63 heavy workers. The mean rate of preoperative Visual Analogical Scale was 8.68. 101 operated patients had 134 PLIF levels and 157 instrumented levels. All operated levels had DDD, with 58 discal hernias including 18 recurrences, 20 congenital spondylolisthesis, 5 degenerative spondylolisthesis.
All patients were reviewed at 3 months and more, and 64 were followed up after 12 to 60 months (mean: 24,63 months);
Results
With Stauffer and Coventry classification, we had 46 good and 11 fair results (86,1% improved patients), and 7 failures. Patients without previous lumbar operation had 94% success.
Discussion
Posterior approach allows all together posterior decompression, instrumentation, and adjunct of cage gives a rapid and durable result. Titanium avoids rupture and is well tolerated. As an adjunct to the cage, posterior instrumentation with pedicular screws improves arthrodesis quality and security.
Conclusion
PLIF with parallelepipedic titanium cage and posterior instrumentation is an arthrodesis technique of future. Primary operated lumbar spines show 94% of success