Donald Ross is a Staff Surgeon in The Operative Care Division at VA Portland Health Care System in Oregon. Donald Ross is an Attending Surgeon and Miner Ross is a Resident Surgeon, both in the Department of Neurological Surgery, Oregon Health & Science University in Portland. Correspondence: Donald Ross (rossdo@ohsu.edu)
Author disclosures The authors report no actual or potential conflicts of interest with regard to this article.
Disclaimer The opinions expressed herein are those of the authors and do not necessarily reflect those of Federal Practitioner, Frontline Medical Communications Inc., the US Government, or any of its agencies.
Introduction: Polyetheretherketone (PEEK) rods for lumbar fusion have been available since 2007. However, literature about their utility is sparse and of mixed outcomes.
Methods: A retrospective review of PEEK rod lumbar fusion cases was performed. Data were analyzed from 108 patients of the senior author Donald Ross who underwent PEEK lumbar fusion.
Results: There were 97 single and 11 2-level fusions. Rates of tobacco use, diabetes mellitus, low bone density, depression, and immunosuppression were 23.1%, 24.1%, 14.8%, 32.4%, and 6.5%, respectively. In the study population, the mean age was 60.2 years, body mass index was 30.1, and there was a mean 31.3 months for follow-up. There were no wound infections or new neurologic deficits. Of 81 patients with > 11 months of follow-up, 70 (86.4%) had an arthrodesis, 8 (9.9%) had no ar throdesis, and 3 (3.7%) were indeterminate. No patients had revision fusion surgery and 2 patients had adjacent level fusions at 27 and 60 months. One patient had an adjacent segment laminectomy at 18 months and one a foraminotomy at 89 months, resulting in a 3.7% adjacent segment surgery rate. Mean preoperative Short Form-36 (SF-36) physical functioning (PF) score and Oswestry Disability Index (ODI) score were 28.9 and 24.8, respectively. Mean SF-36 PF postoperative score at 1 and 2 years were 59.3 and 65, respectively. Mean ODI postoperative score at 1 year was 14.5.
Conclusions: In a large patient cohort lumbar fusion with PEEK rods can be undertaken with low complication rates, satisfactory clinical improvements, low rates of hardware failure or need for revision surgery. Longer follow-up is needed to confirm findings.
Surgical treatment of degenerative lumbar spine disease has been rising steadily in the United States, and an increasing fraction of surgery involves lumbar fusion.1,2 Various techniques are used to accomplish a lumbar fusion, including noninstrumented fusion, anterior lumbar interbody fusion (ALIF), lateral lumbar interbody fusion (XLIF, OLIF), posterior pedicle screw fusion, posterior cortical screw fusion, posterior interbody fusion (TLIF, PLIF), and interspinous process fusion. Rigid, metallic fusion hardware provides high stability and fusion rates, but it likely leads to stress shielding and adjacent segment disease.3 There is interest in less rigid and dynamic stabilization techniques to reduce the risk of adjacent segment disease, such as polyetheretherketone (PEEK) rods, which have been available since 2007. However, literature regarding PEEK rod utility is sparse and of mixed outcomes.3,4 Additional patient reported outcome (PRO) information would be useful to both surgeons and patients. Using institutional data, this review was designed to examine our experience with PEEK rod lumbar fusion and to document PROs.
Methods
The study was approved by the institutional review board at the US Department of Veterans Affairs (VA) Portland Health Care System (VAPHCS) in Oregon with a waiver of authorization. In this retrospective, single center study, data were queried from the senior author’s (DAR) case logs from VA Computerized Patient Record System (CPRS). Electronic medical records, imaging, and PROs of all consecutive patients undergoing lumbar fusion at 1 or 2 levels with PEEK rods for degenerative disease were retrospectively reviewed. Cases of trauma, malignancy, or infection were excluded. From March 2011 through October 2019, 108 patients underwent lumbar fusion with PEEK rods.
