Effectiveness of nano-hydroxyapatite/polyamide-66 Cage in interbody fusion for degenerative lumbar scoliosis_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

HU Jianyu ,  OU Yunsheng , ZHU Yong , LUO Wei , ZHAO Zenghui , DU Xing , LI Jianxiao

Department of Orthopedics, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, P.R.China;

Corresponding author：

OU Yunsheng, Email: ouyunsheng2001@163.com

Keywords：

Degenerative lumbar scoliosis; interbody fusion; nano-hydroxyapatite; polyamide-66; Cage

DOI：

10.7507/1002-1892.201807060

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Objective To explore the effectiveness of nano-hydroxyapatite/polyamide-66 (n-HA/PA66) Cage in interbody fusion for degenerative lumbar scoliosis.Methods A retrospective analysis was designed and conducted for 43 patients, who underwent posterior decompression and n-HA/PA66 Cage interbody fusion with correction of deformity between January 2013 and June 2016. Eighteen cases were single-level fusion (single-level group) and 25 cases were double-level fusion (double-level group). There was no significant difference in gender, age, body mass index, direction of convex, degree of apical rotation, fusion level, the number of osteoporotic patients, pre-operative intervertebral height of fusion segments, coronal Cobb angle, visual analogue score (VAS), and modified Oswestry Disability Index (ODI) between 2 groups (P>0.05). The operation time, intraoperative blood loss, postoperative drainage, hospital stay, and complications of the operation were recorded. Modified ODI, VAS score, and MacNab criteria were adopted to assess clinical outcomes. Radiographic indexes, including intervertebral height of fusion segments, coronal Cobb angle, disc insertion depth, and the bone graft fusion rate, were also evaluated.Results There was no significant difference in operation time, intraoperative blood loss, postoperative drainage, and hospital stay between 2 groups (P>0.05). All patients were followed up 18-62 months (mean, 30.9 months). Wound complications, postoperative delirium, and Cage retropulsion occurred in 4 cases (2 cases in single-level group, 2 cases in double-level group), 1 case of single-level group, and 1 case of double-level group, respectively. The intervertebral height of fusion segments after operation significantly improved compared with preoperative ones in both groups (P<0.05). At last follow-up, the intervertebral height in double-level group was superior to which in single-level group (P<0.05). The coronal Cobb angles after operation significantly improved compared with preoperative ones (P<0.05), and no significant difference was found between 2 groups at each time point (P>0.05). The disc insertion depth showed no significant difference between different time points after operation in 2 groups (P>0.05) and between 2 groups at each time point after operation (P>0.05). Bony fusion was obtained in all patients at last follow-up. The VAS score and modified ODI after operation in both groups were superior to those before operation (P<0.05). The VAS score in double-level group was higher than that in single-level group (P<0.05) at last follow-up, and no significant difference was found in VAS score and modified ODI between 2 groups at other time points (P>0.05). According to the MacNab criteria, the excellent and good rates at last follow-up were 94.4% and 84.0% in single-level group and double-level group, respectively.Conclusion The n-HA/PA66 Cage can effectively restore and maintain the disc height of fusion segment, normal sequence, and biomechanical stability of the spine, and gain favorable effectivenss for degenerative lumbar scoliosis. And double-level fusion is superior to single-level fusion in maintaining disc height of fusion segment.

Citation： HU Jianyu, OU Yunsheng, ZHU Yong, LUO Wei, ZHAO Zenghui, DU Xing, LI Jianxiao. Effectiveness of nano-hydroxyapatite/polyamide-66 Cage in interbody fusion for degenerative lumbar scoliosis. Chinese Journal of Reparative and Reconstructive Surgery, 2019, 33(3): 287-295. doi: 10.7507/1002-1892.201807060 Copy

1.	York PJ, Kim HJ. Degenerative scoliosis. Curr Rev Musculoskelet Med, 2017, 10(4): 547-558.
2.	Tsutsui S, Yoshimura N, Watanuki A, et al. Risk factors and natural history of de novo degenerative lumbar scoliosis in a community-based cohort: the miyama study. Spine Deform, 2013, 1(4): 287-292.
3.	Swamy G, Lopatina E, Thomas KC, et al. The cost effectiveness of minimally invasive spine surgery in the treatment of adult degenerative scoliosis: A comparison of transpsoas and open techniques. Spine J, 2019, 19(2): 339-348.
4.	Brantigan JW, Steffee AD. A carbon fiber implant to aid interbody lumbar fusion. Two-year clinical results in the first 26 patients. Spine (Phila Pa 1976), 1993, 18(14): 2106-2107.
5.	Ailon T, Smith JS, Shaffrey CI, et al. Degenerative spinal deformity. Neurosurgery, 2015, 77(Suppl 4): S75-S91.
6.	Cho KJ, Kim YT, Shin SH, et al. Surgical treatment of adult degenerative scoliosis. Asian Spine J, 2014, 8(3): 371-381.
7.	张志成, 任大江, 孙天胜, 等. 退变性腰椎侧凸合并椎管狭窄的阶梯性治疗策略. 中国修复重建外科杂志, 2011, 25(8): 951-955.
8.	Kuslich SD, Bagby G. The BAK interbody fusion system: early clinical results of treatment for chronic low back pain. The 8th Annual Meeting of the North American Spine Society. San Diego: [s.n], 1993.
9.	王松, 杨函, 杨剑, 等. 多孔磷酸钙/骨基质明胶复合骨水泥修复兔腰椎骨缺损的实验研究. 中国修复重建外科杂志, 2017, 31(12): 1462-1467.
10.	Seaman S, Kerezoudis P, Bydon M, et al. Titanium vs. polyetheretherketone (PEEK) interbody fusion: Meta-analysis and review of the literature. J Clin Neurosci, 2017, 44: 23-29.
11.	郜德龙, 方忠, 孙允龙, 等. 同种异体骨 Cage 在经椎间孔腰椎椎间融合手术中的应用. 中国修复重建外科杂志, 2018, 32(7): 927-932.
12.	赵勃然, 郑修军, 马金荣. 椎间融合器及其材料的研究与进展. 中国组织工程研究, 2017, 21(2): 315-321.
13.	Xiong Y, Ren C, Zhang B, et al. Analyzing the behavior of a porous nano-hydroxyapatite/polyamide 66 (n-HA/PA66) composite for healing of bone defects. Int J Nanomedicine, 2014, 9: 485-494.
14.	温从游, 孟纯阳, 蒋电明. 纳米羟基磷灰石/聚酰胺 66 复合材料的研究及应用. 中国组织工程研究, 2014, 18(3): 464-469.
15.	杨曦, 宋跃明, 孔清泉, 等. 纳米羟基磷灰石/聚酰胺 66 椎间融合器植骨融合治疗下腰椎退变性疾病的近期疗效. 中国修复重建外科杂志, 2012, 26(12): 1425-1429.
16.	邓乾兴, 欧云生, 蒋电明, 等. n-HA/PA66 椎间融合器在颈椎病前路椎间盘切除减压融合术的中期临床疗效. 重庆医科大学学报, 2016, 41(5): 489-494.
17.	Deng QX, Ou YS, Zhu Y, et al. Clinical outcomes of two types of cages used in transforaminal lumbar interbody fusion for the treatment of degenerative lumbar diseases: n-HA/PA66 cages versus PEEK cages. J Mater Sci Mater Med, 2016, 27(6): 102.
18.	Cinotti G, De Santis P, Nofroni I, et al. Stenosis of lumbar intervertebral foramen: anatomic study on predisposing factors. Spine (Phila Pa 1976), 2002, 27(3): 223-229.
19.	Hueng DY, Chung TT, Chuang WH, et al. Biomechanical effects of cage positions and facet fixation on initial stability of the anterior lumbar interbody fusion motion segment. Spine (Phila Pa 1976), 2014, 39(13): E770-E776.
20.	Kurra S, Lavelle WF, Silverstein MP, et al. Long-term outcomes of transforaminal lumbar interbody fusion in patients with spinal stenosis and degenerative scoliosis. Spine J, 2018, 18(6): 1014-1021.
21.	Landham PR, Don AS, Robertson PA. Do position and size matter? An analysis of cage and placement variables for optimum lordosis in PLIF reconstruction. Eur Spine J, 2017, 26(11): 2843-2850.
22.	邓乾兴, 欧云生, 朱勇, 等. 经椎间孔单节段腰椎椎间融合术后融合器下沉的危险因素分析. 中华骨科杂志, 2018, 38(3): 156-163.
23.	Aoki Y, Yamagata M, Nakajima F, et al. Examining risk factors for posterior migration of fusion cages following transforaminal lumbar interbody fusion: a possible limitation of unilateral pedicle screw fixation. J Neurosurg Spine, 2010, 13(3): 381-387.
24.	Khajavi K, Shen AY. Two-year radiographic and clinical outcomes of a minimally invasive, lateral, transpsoas approach for anterior lumbar interbody fusion in the treatment of adult degenerative scoliosis. Eur Spine J, 2014, 23(6): 1215-1223.
25.	孟纯阳, 安洪, 蒋电明. 新型纳米骨关节修复重建材料的生物活性及近期对机体钙磷代谢的影响. 中国骨与关节损伤杂志, 2005, 20(10): 682-684.
26.	Pan FM, Wang SJ, Yong ZY, et al. Risk factors for cage retropulsion after lumbar interbody fusion surgery: Series of cases and literature review. Int J Surg, 2016, 30: 56-62.
27.	马龙冰, 贾云兵, 宋跃明, 等. 聚氨基酸/纳米羟基磷灰石/硫酸钙椎间融合器在腰椎融合术中的初步应用. 中国修复重建外科杂志, 2016, 30(3): 328-335.
28.	Abbushi A, Cabraja M, Thomale UW, et al. The influence of cage positioning and cage type on cage migration and fusion rates in patients with monosegmental posterior lumbar interbody fusion and posterior fixation. Eur Spine J, 2009, 18(11): 1621-1628.
29.	Wang L, Zhang B, Chen S, et al. A validated finite element analysis of facet joint stress in degenerative lumbar scoliosis. World Neurosurg, 2016, 95: 126-133.
30.	Zhang XN, Sun XY, Meng XL, et al. Risk factors for medical complications after long-level internal fixation in the treatment of adult degenerative scoliosis. Int Orthop, 2018, 42(11): 2603-2612.

1. York PJ, Kim HJ. Degenerative scoliosis. Curr Rev Musculoskelet Med, 2017, 10(4): 547-558.
2. Tsutsui S, Yoshimura N, Watanuki A, et al. Risk factors and natural history of de novo degenerative lumbar scoliosis in a community-based cohort: the miyama study. Spine Deform, 2013, 1(4): 287-292.
3. Swamy G, Lopatina E, Thomas KC, et al. The cost effectiveness of minimally invasive spine surgery in the treatment of adult degenerative scoliosis: A comparison of transpsoas and open techniques. Spine J, 2019, 19(2): 339-348.
4. Brantigan JW, Steffee AD. A carbon fiber implant to aid interbody lumbar fusion. Two-year clinical results in the first 26 patients. Spine (Phila Pa 1976), 1993, 18(14): 2106-2107.
5. Ailon T, Smith JS, Shaffrey CI, et al. Degenerative spinal deformity. Neurosurgery, 2015, 77(Suppl 4): S75-S91.
6. Cho KJ, Kim YT, Shin SH, et al. Surgical treatment of adult degenerative scoliosis. Asian Spine J, 2014, 8(3): 371-381.
7. 张志成, 任大江, 孙天胜, 等. 退变性腰椎侧凸合并椎管狭窄的阶梯性治疗策略. 中国修复重建外科杂志, 2011, 25(8): 951-955.
8. Kuslich SD, Bagby G. The BAK interbody fusion system: early clinical results of treatment for chronic low back pain. The 8th Annual Meeting of the North American Spine Society. San Diego: [s.n], 1993.
9. 王松, 杨函, 杨剑, 等. 多孔磷酸钙/骨基质明胶复合骨水泥修复兔腰椎骨缺损的实验研究. 中国修复重建外科杂志, 2017, 31(12): 1462-1467.
10. Seaman S, Kerezoudis P, Bydon M, et al. Titanium vs. polyetheretherketone (PEEK) interbody fusion: Meta-analysis and review of the literature. J Clin Neurosci, 2017, 44: 23-29.
11. 郜德龙, 方忠, 孙允龙, 等. 同种异体骨 Cage 在经椎间孔腰椎椎间融合手术中的应用. 中国修复重建外科杂志, 2018, 32(7): 927-932.
12. 赵勃然, 郑修军, 马金荣. 椎间融合器及其材料的研究与进展. 中国组织工程研究, 2017, 21(2): 315-321.
13. Xiong Y, Ren C, Zhang B, et al. Analyzing the behavior of a porous nano-hydroxyapatite/polyamide 66 (n-HA/PA66) composite for healing of bone defects. Int J Nanomedicine, 2014, 9: 485-494.
14. 温从游, 孟纯阳, 蒋电明. 纳米羟基磷灰石/聚酰胺 66 复合材料的研究及应用. 中国组织工程研究, 2014, 18(3): 464-469.
15. 杨曦, 宋跃明, 孔清泉, 等. 纳米羟基磷灰石/聚酰胺 66 椎间融合器植骨融合治疗下腰椎退变性疾病的近期疗效. 中国修复重建外科杂志, 2012, 26(12): 1425-1429.
16. 邓乾兴, 欧云生, 蒋电明, 等. n-HA/PA66 椎间融合器在颈椎病前路椎间盘切除减压融合术的中期临床疗效. 重庆医科大学学报, 2016, 41(5): 489-494.
17. Deng QX, Ou YS, Zhu Y, et al. Clinical outcomes of two types of cages used in transforaminal lumbar interbody fusion for the treatment of degenerative lumbar diseases: n-HA/PA66 cages versus PEEK cages. J Mater Sci Mater Med, 2016, 27(6): 102.
18. Cinotti G, De Santis P, Nofroni I, et al. Stenosis of lumbar intervertebral foramen: anatomic study on predisposing factors. Spine (Phila Pa 1976), 2002, 27(3): 223-229.
19. Hueng DY, Chung TT, Chuang WH, et al. Biomechanical effects of cage positions and facet fixation on initial stability of the anterior lumbar interbody fusion motion segment. Spine (Phila Pa 1976), 2014, 39(13): E770-E776.
20. Kurra S, Lavelle WF, Silverstein MP, et al. Long-term outcomes of transforaminal lumbar interbody fusion in patients with spinal stenosis and degenerative scoliosis. Spine J, 2018, 18(6): 1014-1021.
21. Landham PR, Don AS, Robertson PA. Do position and size matter? An analysis of cage and placement variables for optimum lordosis in PLIF reconstruction. Eur Spine J, 2017, 26(11): 2843-2850.
22. 邓乾兴, 欧云生, 朱勇, 等. 经椎间孔单节段腰椎椎间融合术后融合器下沉的危险因素分析. 中华骨科杂志, 2018, 38(3): 156-163.
23. Aoki Y, Yamagata M, Nakajima F, et al. Examining risk factors for posterior migration of fusion cages following transforaminal lumbar interbody fusion: a possible limitation of unilateral pedicle screw fixation. J Neurosurg Spine, 2010, 13(3): 381-387.
24. Khajavi K, Shen AY. Two-year radiographic and clinical outcomes of a minimally invasive, lateral, transpsoas approach for anterior lumbar interbody fusion in the treatment of adult degenerative scoliosis. Eur Spine J, 2014, 23(6): 1215-1223.
25. 孟纯阳, 安洪, 蒋电明. 新型纳米骨关节修复重建材料的生物活性及近期对机体钙磷代谢的影响. 中国骨与关节损伤杂志, 2005, 20(10): 682-684.
26. Pan FM, Wang SJ, Yong ZY, et al. Risk factors for cage retropulsion after lumbar interbody fusion surgery: Series of cases and literature review. Int J Surg, 2016, 30: 56-62.
27. 马龙冰, 贾云兵, 宋跃明, 等. 聚氨基酸/纳米羟基磷灰石/硫酸钙椎间融合器在腰椎融合术中的初步应用. 中国修复重建外科杂志, 2016, 30(3): 328-335.
28. Abbushi A, Cabraja M, Thomale UW, et al. The influence of cage positioning and cage type on cage migration and fusion rates in patients with monosegmental posterior lumbar interbody fusion and posterior fixation. Eur Spine J, 2009, 18(11): 1621-1628.
29. Wang L, Zhang B, Chen S, et al. A validated finite element analysis of facet joint stress in degenerative lumbar scoliosis. World Neurosurg, 2016, 95: 126-133.
30. Zhang XN, Sun XY, Meng XL, et al. Risk factors for medical complications after long-level internal fixation in the treatment of adult degenerative scoliosis. Int Orthop, 2018, 42(11): 2603-2612.

Chinese Journal of Reparative and Reconstructive Surgery

Effectiveness of nano-hydroxyapatite/polyamide-66 Cage in interbody fusion for degenerative lumbar scoliosis

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