M Rickert1, M Arabmotlagh, C Carstens, E Behrbalk, M Rauschmann, C Fleege. 1. Abteilung für Wirbelsäulenorthopädie, Orthopädische Universitätsklinik Friedrichsheim gGmbH, Marienburgstraße 2, 60528, Frankfurt am Main, Deutschland, marcus.rickert@friedrichsheim.de.
Abstract
BACKGROUND: Sagittal imbalance, adjacent segment degeneration, and loss of correction due to cage sintering are the main reasons for revision surgery after lumbar fusion. Based on the experience from hip and knee replacement surgery, preoperative software-assisted planning combined with the corresponding cages is helpful to achieve better long-term results. OBJECTIVES: Evaluation of the procedure regarding intraoperative application of preoperative planning and examination to what extent the planning was correct. MATERIALS AND METHODS: In all, 30 patients were included in the period from September 2012 to May 2013 in an observational study, planned preoperatively with the planning software, and treated with the corresponding PLIF cages. The radiological evaluation was performed by thin-layer CT after 3 months. RESULTS: A total of 24 (80%) patients were followed up after 3 months. In these 24 patients, the preoperative planning actually was correct in 17 cases with the intraoperatively implanted cage, which corresponds to a match of about 71%. The fusion rate for these 24 patients who underwent full examinations was 91.7%. CONCLUSION: The results of this observational study to evaluate the planning of intervertebral cages show positive experience with this novel therapeutic concept. Despite the limited number of participants, good results were observed for the intraoperative implementation of the planned cages and an adequate fusion rate was obtained. Irrespective of this, a software-based surgical planning must be questioned critically any time. Ultimately, it is the surgeon's responsibility to modify the planned procedure intraoperatively if necessary. Currently, the influence of this planning regarding the long-term course and the important question of adjacent segment instability remains unanswered.
BACKGROUND: Sagittal imbalance, adjacent segment degeneration, and loss of correction due to cage sintering are the main reasons for revision surgery after lumbar fusion. Based on the experience from hip and knee replacement surgery, preoperative software-assisted planning combined with the corresponding cages is helpful to achieve better long-term results. OBJECTIVES: Evaluation of the procedure regarding intraoperative application of preoperative planning and examination to what extent the planning was correct. MATERIALS AND METHODS: In all, 30 patients were included in the period from September 2012 to May 2013 in an observational study, planned preoperatively with the planning software, and treated with the corresponding PLIF cages. The radiological evaluation was performed by thin-layer CT after 3 months. RESULTS: A total of 24 (80%) patients were followed up after 3 months. In these 24 patients, the preoperative planning actually was correct in 17 cases with the intraoperatively implanted cage, which corresponds to a match of about 71%. The fusion rate for these 24 patients who underwent full examinations was 91.7%. CONCLUSION: The results of this observational study to evaluate the planning of intervertebral cages show positive experience with this novel therapeutic concept. Despite the limited number of participants, good results were observed for the intraoperative implementation of the planned cages and an adequate fusion rate was obtained. Irrespective of this, a software-based surgical planning must be questioned critically any time. Ultimately, it is the surgeon's responsibility to modify the planned procedure intraoperatively if necessary. Currently, the influence of this planning regarding the long-term course and the important question of adjacent segment instability remains unanswered.
Authors: T R Lehmann; K F Spratt; J E Tozzi; J N Weinstein; S J Reinarz; G Y el-Khoury; H Colby Journal: Spine (Phila Pa 1976) Date: 1987-03 Impact factor: 3.468