• World Neurosurg · Mar 2022

    Static cage morphology in short-segment transforaminal lumbar interbody fusions is associated with alterations in foraminal height but not clinical outcomes.

    • Nathaniel Toop, Andrew Grossbach, David Gibbs, Asad Akhter, Alexander Keister, Dominic Maggio, James Oosten, Kyle Deistler, Ty Gilkey, H Francis Farhadi, and Stephanus Viljoen.
    • Department of Neurological Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.
    • World Neurosurg. 2022 Mar 1; 159: e389-e398.

    IntroductionSteerable "banana" cages have been posited to increase segmental lordosis in short-segment transforaminal lumbar interbody fusions (TLIF). The same is not necessarily true for straight "bullet" cages. Although increased lordosis is generally thought to be advantageous, a potential complication is decreased foraminal height. Here we evaluate for any association between cage type and change in foraminal height and clinical outcomes following short-segment TLIFs.MethodsWe retrospectively reviewed consecutive 1- and 2-level TLIFs with bilateral facetectomies with minimum 1-year clinical and radiographic follow-up. Two cohorts were based on cage morphology: steerable "banana" cage or straight "bullet" cage. Patient reported outcome measures (PROMs), radiographic measurements, and revision rates were compared.ResultsA total of 46 patients with 53 straight and 95 patients with 131 steerable cage levels were included. Steerable cages showed increased segmental lordosis (9.1° vs. 13.5°, P < 0.001) and decreased foraminal height (20.3 vs. 18.5 mm, P < 0.001) after surgery. Straight cages demonstrated similar segmental lordosis (8.7° vs 8.1°, P = 0.30) and foraminal height (19.4 vs 20.0 mm, P < 0.065). Both cohorts showed improved PROMs at last follow-up (P ≤ 0.005). Subanalysis comparing patients who had increased or decreased foraminal height revealed similarly improved PROMs between cohorts. Revision rates at 1 year were similar between cohorts (4.3% for straight and 3.2% for steerable group, P = 0.72).ConclusionsAlthough the increased segmental lordosis afforded by placement of steerable cages may decrease foraminal height after short segment TLIF, clinical outcomes are not negatively affected by this association.Copyright © 2021 Elsevier Inc. All rights reserved.

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