Abstract
BackgroundThe benefits of posterior lumbar fusion surgery with orthotopic paraspinal muscle-pediculated bone flaps are well established. However, the problem of non-union due to mechanical support is not completely resolved. The aim of the study was to compare the efficacy of polyether ether ketone (PEEK) rod device with conventional titanium devices in the posterior lumbar fusion surgery with orthotopic paraspinal muscle-pediculated bone flaps.MethodsThis was a randomized controlled study with an experimental animal model. Thirty-two mongrel dogs were randomly divided into two groups—control group (n = 16), which received the titanium device and the treatment group (n = 16), which received PEEK rods. The animals were sacrificed 8 or 16 weeks after surgery. Lumbar spines of dogs in both groups were removed, harvested, and assessed for radiographic, biomechanical, and histological changes.ResultsResults in the current study indicated that there was no significant difference in the lumbar spine of the control and treatment groups in terms of radiographic, manual palpation, and gross examination. However, certain parameters of biomechanical testing showed significant differences (p < 0.05) in stiffness and displacement, revealing a better fusion (treatment group showed decreased stiffness with decreased displacement) of the bone graft. Similarly, the histological analysis also revealed a significant fusion mass in both treatment and control groups (p < 0.05).ConclusionsThese findings revealed that fixation using PEEK connecting rod could improve the union of the bone graft in the posterior lumbar spine fusion surgery compared with that of the titanium rod fixation.
Highlights
The benefits of posterior lumbar fusion surgery with orthotopic paraspinal muscle-pediculated bone flaps are well established
Spinal arthrodesis was achieved using a WEGO/GB1Z Internal Fixator (Wego Ortho, Inc, Weihai, People’s Republic of China) that consists of four 4-mm diameter and 20-mm-long titanium pedicle screws which were placed in L5 and L6 bilaterally and were connected with two 3-mm diameter titanium rods
Radiographic evaluation and manual palpation Radiographic evaluation performed at 8 and 16 weeks after surgery did not show any significant differences between the control and treatment groups
Summary
The benefits of posterior lumbar fusion surgery with orthotopic paraspinal muscle-pediculated bone flaps are well established. The aim of the study was to compare the efficacy of polyether ether ketone (PEEK) rod device with conventional titanium devices in the posterior lumbar fusion surgery with orthotopic paraspinal muscle-pediculated bone flaps. In contrast to the above findings, dynamic stabilizing devices, which were made up of “compliant” material like polyether ether ketone (PEEK), reduce the risk of arthrodesis-induced complication of ASDs [9, 10]. The rigidity of titanium rods increases stress at the bone-screw interface, which increases the risk of fracture at that level. PEEK imposes less stress on the bone-screw interface due to its less rigid nature and decreases the incidence of degenerative diseases, fracture of pedicles, and avulsion of bone from the device [11]
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