2022, Vol. 26 ›› Issue (33): 5335-5341

Application of height adjustable titanium fusion cage in endoscopic lumbar fusion

Xu Wei1, Li Zhifei2, Wan Tong1, Yu Weibo2, Zhang Yisheng2, Zhou Jinyan2, Bu Xianzhong1, Zhong Yuanming2   

Abstract: BACKGROUND: Percutaneous endoscopic interbody foraminal interbody fusion is an advanced minimally invasive method for the treatment of lumbar degenerative diseases. The traditional interbody fusion cage is not fully suitable for minimally invasive surgery. The choice of fusion cage for endoscopic lumbar fusion is still controversial.  
OBJECTIVE: To explore the clinical effect of percutaneous spinal endoscopic implantation of height adjustable titanium fusion cage for interbody fusion in the treatment of lumbar degenerative diseases.
METHODS: A retrospective study investigated 55 patients who underwent percutaneous endoscopic lumbar fusion in the Department of Orthopedics of First Affiliated Hospital of Guangxi University of Chinese Medicine from December 2018 to June 2019. According to the different types of fusion cages implanted, they were divided into two groups. The stretch group (n=23) was implanted with a retractable height adjustable titanium fusion cage, and the general group (n=32) was used with an ordinary lumbar fusion cage. Postoperative complications were recorded in the two groups. The JOA score, Visual Analogue Scale score, and Oswestry Disability Index in the two groups were compared before and after treatment. This study was approved by the Ethics Committee of the First Affiliated Hospital of Guangxi University of Chinese Medicine.  
RESULTS AND CONCLUSION: (1) All 55 patients were followed-up for more than 12 months. All patients obtained bony fusion without complications, such as internal fixation loosening, fracture, fusion cage displacement, or settlement. (2) Compared with those before treatment, Visual Analogue Scale scores of low back pain and leg pain, JOA score, and Oswestry Disability Index were significantly improved in the two groups at 2 weeks, 3, 6, and 12 months after operation
(P < 0.05). JOA score at 12 months and Oswestry Disability Index at 6 and 12 months were significantly better in the stretch group than those in the general group (P < 0.05). (3) Compared with those before treatment, the height of the intervertebral space, the height of the intervertebral foramen of the fusion segment, the lordosis angle of the operative segment, and the lumbar lordosis angle of the two groups were significantly improved after treatment (P < 0.05). The height of the intervertebral space, the height of the intervertebral foramen of the fusion segment, the lordosis angle of the operative segment, and the lumbar lordosis angle were better in the stretch group than those of the general group at 5 days and 12 months after treatment (P < 0.05). (4) It is concluded that percutaneous endoscopic lumbar fusion is a reliable minimally invasive method for the treatment of lumbar degenerative diseases. Its combination with highly adjustable titanium fusion cage can improve its clinical efficacy.
Key words: lumbar degenerative disease, height adjustable fuser, spinal endoscope, intervertebral fusion, minimally invasive lumbar surgery, intervertebral space height, lumbar lordosis