Allograft implants for posterior lumbar interbody fusion: results comparing cylindrical dowels and impacted wedges

With the proliferation of implant types available for use in posterior lumbar interbody fusion (PLIF) procedures, the choices for surgeons have become increasingly complex. The goal of this study was to retrospectively review a series of 49 patients who underwent PLIF with the use of allograft cylindrical threaded cortical bone dowels (TCBDs) and allograft impacted wedges. Nerve root injury rates, fusion rates, and clinical outcomes of the allograft impacted wedge group are compared with those in the allograft cylindrical TCBD group.

We performed a retrospective chart and radiographic review of 49 patients. Twenty-seven patients underwent PLIF with impacted allograft wedges, and 22 patients underwent PLIF with allograft cylindrical TCBD. Permanent nerve root injury rates, fusion rates, and clinical outcomes were assessed on the basis of a minimum of 1 year of follow-up data in this nonconsecutive series.

Permanent nerve root injuries in the impacted wedge and TCBD groups were documented with physical examinations conducted pre- and postoperatively. The cylindrical TCBD group showed a 13.6% rate of permanent nerve root injury, and the impacted wedge group demonstrated a 0% rate, and these rates were statistically significant (analysis of variance, P = 0.049). The fusion rate at a mean of 13.9 months of follow-up was 95.4% in patients in whom the cylindrical TCBD was implanted and 88.9% after a mean of 17.4 months of follow-up in patients in whom impacted wedges were used. The fusion rate difference between the TCBD and impacted wedge groups was not significant. The satisfactory outcome rate was 72.7% for the TCBD group and 85.1% for the impacted wedge group, and the impacted wedge group was found to have a significantly higher rate of satisfactory outcomes (P = 0.016, analysis of variance). Analysis of the patient outcomes in the TCBD and impacted wedge groups according to sex, mean length of follow-up, workman's compensation claim rate, and smoking habit yielded no significant difference.

With a minimum of 1 year of follow-up in this nonconsecutive series of 49 patients, a comparison of the use of allograft TCBD versus allograft impacted wedges in PLIF procedures reveals a statistically significant increase in permanent nerve root injury rates with the use of cylindrical TCBD implants as compared with impacted allograft wedges. There is no difference between the two groups in terms of fusion rates, and clinical outcomes with the use of impacted wedges were significantly better.