ARTRODESE LOMBAR INTERSOMÁTICA TRANSFORAMINAL: COMPARADO AUTOENXERTO E CAGE-PEEK

RENATO SCAPUCIN SORPRESO

Universidade Federal de São Paulo, Paulista School of Medicine, Sports Traumatology Center, São Paulo, SP, Brazil.

DÉLIO EULÁLIO MARTINS

Universidade Federal de São Paulo, Paulista School of Medicine, Sports Traumatology Center, São Paulo, SP, Brazil.

Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.

MICHEL KANAS

Universidade Federal de São Paulo, Paulista School of Medicine, Sports Traumatology Center, São Paulo, SP, Brazil.

Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.

ISABEL CRISTINA ESPOSITO SORPRESO

Universidade de São Paulo, Medical School, São Paulo, SP, Brazil.

NELSON ASTUR

Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.

Santa Casa de São Paulo, Department of Orthopedics and Traumatology “Fernandinho Simonsen Pavilion”, São Paulo, SP, Brazil.

MARCELO WAJCHENBERG

Universidade Federal de São Paulo, Paulista School of Medicine, Sports Traumatology Center, São Paulo, SP, Brazil.

Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.

Correspondence: Renato Scapucin Sorpreso. Rua Estado de Israel, 636, Vila Clementino, São Paulo, SP, Brazil, 04022001. renatosso@yahoo.com

AUTHORS’ CONTRIBUTIONS: Each author contributed individually and significantly to the development of this article: RSS: performed surgeries, data analysis, writing, review and intellectual concept of the article; DEM: data analysis and writing of the article; MK: data analysis and writing of the article; ICES: data analysis and writing of the article; NA: intellectual concept and critical review of the article; MW: intellectual concept and critical review of the article. All authors approved the final version of the manuscript.

Variables	N	%
Gender
Female	40	43
Male	53	57
Number of Affected Locations
1 location	63	67.7
2 locations	30	32.3
Comorbidities	5	18.5
Smoking habit	26	28.3.
Physical Activity
Preoperative	37	40.2
Post-operative	48	52.2
Employment	83	90.2
Pfirrmann
III	7	5.4
IV	116	89.9
V	6	4.7
Pathologies
Degenerative discopathy with compression	58	62.4
Degenerative discopathy without compression	6	6.3
Spondylolisthesis	18	19.4.
Central stenosis	1	1.1
Pseudoarthrosis	9	9.7
Synovial cyst	1	1.1
Strength deficit	59	63.4
Operated level
L3-L4
L4-L5	15	16.1
L5-S1	28	30.1
L3-L4 + L4-L5	6	6.5
L4-L5 + L5-S1	44	47.3
Reoperation due to mis-positioning	1	1.1
	Mean (SD)	(min-max)
Age	43.7 (9.0)	27-68
Time of prior treatment	16.4 (11.2)	4 - 48
ODI	31.5 (8.3)	10 - 50

Variables	N 93 (100%)	Graft (n = 48; 51.6%)	PEEK (n = 45; 48.4%)	p*
Variables	N 93 (100%)	n (%)
Male	40 (43.0)	27 (56.2)	26 (57.8)	0.882
More than one affected location	30 (67.7)	13 (27.1)	17 (37.8)	0.270
Comorbidities	5 (18.5)	4 (8.3)	1 (2.2)	0.192
Smoking habit	26 (29.3)	14 (29.8)	12 (26.7)	0.740
Preoperative Physical Activity	37 (40.2)	14 (29.8)	23 (51.1)	0.037
Employment	83 (90.2)	44 (93.6)	39 (86.7)	0.262
Pathologies, n (%)
DD with compression	58	32 (66.7)	26 (57.8)	0.016
DD without compression	6	6 (12.5)	0 (0.0)
Spondylolisthesis	18	9 (18.8)	9 (20.0)
Central stenosis	1	0 (0)	1 (2.2)
Pseudoarthrosis	9	1 (2.1)	8 (17.8)
Synovial cyst	1	0 (0)	1 (2.2)
	Mean	Median (95%CI)		p**
Age (years)	43.7	42.5 (39.7; 46.3)	42.0 (39.0; 47.2)	0.895
Duration of pre-operative treatment (months)	16.4	12.0 (9.0 - 18.0)	12.0 (12.0 - 18.0)	0.668

Variables	Graft (51.6%; n = 48)	PEEK (48.4%; n = 45)	p*
Sciatica, n (%)	39 (81.3)	38 (84.4)	0.683
Strength deficit, n (%)	34 (70.8)	25 (55.6)	0.126
Lesion site, n (%)
L3-L4	2 (4.2)	1 (1.8)	0.63
L4-L5	21 (43.7)	29 (50.9)
L5-S1	25 (52.1)	27 (47.3)
Pfirrmann
III	3 (4.5)	4 (6.0)	0.617
IV	59 (89.4)	57 (83.8)
V	4 (6.1)	7 (10.2)
Oswestry (Disability classification), n (%)
Minimal disability (0 -\| 20)	0 (0.0)	1 (2.2)	0.31
Moderate disability (21 -\| 40)	1 (2.1)	4 (8.9)
Severe disability (41 -\| 60)	21 (44.7)	18 (40.0)
Crippled (61 -\| 80)	15 (31.9)	17 (37.8)
Bed-bound or exaggerating symptoms (80 -\| 100)	10 (21.3)	5 (11.1)
	Median (95%CI)		p**
Lumbar lordosis in degrees of angulation, mean (95%CI)	53.0 (48.6; 57.5)	54.1 (48.8; 59.3)	0.763
Height of discs in pixels, average (95%CI)
L3-L4	19.1 (14.6; 23.5)	27.5***	-
L4-L5	22.2 (17.6; 26.8)	26.3 (22.8; 28.9)	0.139
L5-S1	25.1 (20.6; 29.6)	24.4 (20.8; 27.9)	0.791
Disc angulation, mean (95%CI)
L3-L4	6.1 (- 30.7; 42.9)	0,2***	-
L4-L5	6.8 (4.7; 8.2)	5.3 (3.4; 7.2)	0.283
L5-S1	7.4 (5.4; 9.4)	7.9 (5.9; 9.9)	0.719

Variables	Graft (51.6%; n = 48)	PEEK (48.4%; n = 45)	p*
Sciatica, n (%)
Stable	9 (18.8)	7 (15.6)	0.547
Improvement	39 (81.2)	37 (82.2)
Worsening	0 (0)	1 (2.2)
Analysis of muscle strength, n (%)	34 (70.8)	24 (53.3)	0.082
Return to work, n (%)	37 (78.7)	32 (71.1)	0.472
Practice of physical activity, n (%)	22 (46.8)	26 (57.8)	0.292
			p**
Months of absence, median and 95%CI	7.0 (6.0; 9.0)	7.0 (6.0; 10.8)	0.889

Variables	Graft (51.6%; n = 48)				PEEK (48.4%; n = 45)				Postoperative Difference	p**
Variables	Preoperative	Postoperative	Difference	p*	Preoperative	Postoperative	Difference	p*
Oswestry (score in % mean, 95%CI)	64.7	20	- 44.7	< 0.001	61.2	22.3	- 38.9	< 0.001	5.0	0.060
Oswestry (score in % mean, 95%CI)	(60.1; 69.3)	(13.9; 26.1)	(- 50.8; 38.6)	< 0.001	(55.9; 66.4)	(16.4; 28.1)	(- 45.0; 32.7)	< 0.001	(- 0.08; 10.1)	0.060
Lumbar lordosis (mean angulation, 95%CI)	53.5	52.9	- 0.58	0.769	53.6	54.1	0.48	0.747	2.4	0.388
Lumbar lordosis (mean angulation, 95%CI)	(48.8; 58.2)	(48.3; 57.5)	(- 4.6; 3.5)	0.769	(48.3; 58.9)	(50.1; 58.0)	(- 2.5; 3.5)	0.747	(- 3.2; 8.0)	0.388
Disc height (average pixel count, 95%CI)
L3-L4***	19.1	13	- 6.1	0.195	27.4	39.3	- 11.8	-	17.9	-
L3-L4***	(14.6; 23.5)	(- 7.0; 33.0)	(- 30.5; 18.4)	0.195	27.4	39.3	- 11.8	-	17.9	-
L4-L5	22.2	20.5	- 1.6	0.242	27	26.5	- 0.5	0.724	1.2	0.548
L4-L5	(17.6; 26.8)	(15.8; 25.3)	(- 4.4; 1.2)	0.242	(23.3; 30.6)	(22.7; 30.2)	(- 3.2; 2.2)	0.724	(- 2.9; 0.9)	0.548
L5-S1	24.5	22.6	- 1.8	0.29	25	23.1	- 1.9	0.148	- 0.07	0.970
L5-S1	(10.1; 28.8)	(19.1; 26.2)	(- 5.3; 1.7)	0.29	(21.3; 28.7)	(19.1; 27.1)	(- 4.5; 0.7)	0.148	(- 4.3; 4.1)	0.970
Disc angulation (mean in degrees, 95%CI)
L3-L4***	6.1	5.2	- 0.9	0.862	0.2	1.5	1.3	-	- 2.2	-
L3-L4***	(- 30.7; 42.9)	(- 10.0; 20.4)	(- 53.0; 51.2)	0.862	0.2	1.5	1.3	-	- 2.2	-
L4-L5	6.9	7.3	0.4	0.533	5.3	6.8	1.5	0.059	1.01	0.285
L4-L5	(4.7; 9.0)	(5.7; 8.8)	(- 0.9; 1.7)	0.533	(3.4; 7.2)	(5.8; 7.8)	(- 0.1; 3.1)	0.059	(- 0.94; 3.2)	0.285
L5-S1	7.6	9.2	1.6	0.07	7.4	7.6	0.2	0.807	- 1.4	0.269
L5-S1	(5.5; 9.6)	(7.6; 10.7)	(- 0.14; 3.3)	0.07	(5.6; 9.1)	(6.0; 9.2)	(- 1.6; 2.0)	0.807	(- 3.9; 1.1)	0.269

Brasil