Clinical results of single-level posterior lumbar interbody fusion using the Brantigan I/F carbon cage filled with a mixture of local morselized bone and bioactive ceramic granules

Study Design. A retrospective study to evaluate the results of single-level posterior lumbar interbody fusion (PLIF) using the Brantigan I/F cage (DePuy AcroMed Corp., Raynham, MA) filled with a mixture of local morselized autologous bone and bioactive ceramic granules. Objectives. To report the clinical and radiologic results of PLIF using the Brantigan I/F cage for lumbar degenerative pathologies with instability. Summary of Background Data. The Brantigan I/F cage for PLIF was designed to improve the fusion success of interbody fusion by separating the mechanical and biologic functions of PLIF using an implant device and autologous bone from the iliac crest. Although high fusion rates have been reported, donor site morbidity caused by bone harvest from the iliac crest remains a concern. The possibility of accomplishing cage PLIF using a mixture of local morselized bone and a bone extender was studied. Methods. A total of 25 patients underwent single-level PLIF using the Brantigan I/F cage filled with a mixture of local morselized bone and bioactive ceramic granules. All patients were observed for more than 2 years (average 2 years 7 months) and evaluated by clinical rating and radiograph. Results. Preoperative Japanese Orthopedic Association clinical scores were significantly improved in all patients at the time of follow-up. The average improvement rate was 83.1%. There were no serious complications. Minor complications included two dural tears and two cases of thrombophlebitis. No patient required blood transfusion. All patients achieved radiographic fusion and radiographic stability, although two patients fused in a collapsed position. Regional alignment of the operated segments was restored at surgery and maintained at the time of final follow-up. There were statistical improvements in percent slip and percent posterior disc height in patients with spondylolisthesis. Conclusions. Posterior lumbar interbody fusion using the Brantigan I/F cage with a mixture of local morselized bone and bioactive ceramic granules can yield a solid union with satisfactory regional alignment and adequate disc height without harvest of iliac crest bone.