124. Place des cages lombaires - Lumbar cage in lumbar surgery

N Manzo, D Memia-Zolo, N Salloum (Fort de France)

Following the deficiencies of bone fusion obtained by posterior or posterior-lateral arthrodesis, the 1980s saw the birth of the intersomatic cages.

These implants, oblong, were first designed in titanium, to meet strength requirements, and have improved over time, now with types of polymer materials, with or without carbon fibers, whose benefits are to be radio-transparent, and to have an elasticity close to cortical bone.
They are then filled with bone graft during surgery.

Their goal is to improve bone fusion between adjacent vertebral bodies within an arthrodesis, whose main indications are: degenerative disc disease with painful symptoms, canal stenosis, spondylolisthesis (grade 1), disc diseases after many surgeries.

They are therefore used as a complement of arthrodesis, in order to improve results.
Limits of their use are mainly patients with osteoporosis, or with degenerative lesions with thinning of the disc.

The use of lumbar cage has its justification and its place in the functional improvement of patients, because they increase the initial stability in the context of arthrodesis, they help maintain the disc height in the long term (and thus, restoration of lordosis ), give a better percentage of fusion (91% at 1 year), and improve the release of the nervous roots.
It should be borne in mind that the clinical benefit will be real only in very selected indications.

Mindful that they are an important part of the armamentarium in the lumbar arthrodesis surgery, everything portends future technical improvements, perhaps with the introduction of routine bone-inducing agents in appropriate cages, as has been proposed.

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