Clinical results of a single central interbody fusion cage and transpedicle screws fixation for recurrent herniated lumbar disc and low-grade spondylolisthesis.

BACKGROUND: The posterior lumbar interbody fusion (PLIF) procedure allows restoration of the weight-bearing capacity to a more physiological ventral position and maintenance of disc space height. However, the procedure can be technically difficult and may cause complications. It has always been performed bilaterally with paired cages; a single central cage has not been commonly used.
METHODS: Twenty-eight patients who met the interbody fusion criteria from March 1999 through November 2001 were included in the study. Surgery was performed from the posterior with a single central cage supplemented with transpedicle screws. The follow-up period ranged from 8 to 39 months with a mean of 14.4 months. Clinical outcomes were assessed. Dynamic radiography for fusion mass was interpreted by an independent radiologist.
RESULTS: Overall, 92.86% of the patients were satisfied with their conditions after surgery. Radiography study showed the rate of bony fusion being 82.14%. Fibrous union was noted in five patients. No migration of the cage was observed. One patient experienced laceration of the dura without clinical sequelae. One patient had transient paresthesia and recovered within 2 weeks. One patient had transient bladder atony and recovered within 3 days. Overall, the complications were negligible and none of the patients sustained a motor deficit and permanent complication.
CONCLUSIONS: The PLIF procedure using a single, central cage combined with bilateral pedicle screws fixation obtained satisfactory outcome within a short-term or long-term follow-up period. Since the implant-related complications have seldom been observed, it may be used as an alternative option for recurrent lumbar disc herniation or low grade spondylolisthesis with apparent degenerative disc disease.