• World Neurosurg · Mar 2022

    Expandable versus Static Transforaminal Lumbar Interbody Fusion Cages: 1-year Radiographic Parameters and Patient-Reported Outcomes.

    • Josha Woodward, Lacin Koro, Dominick Richards, Christopher Keegan, Richard D Fessler, and Richard G Fessler.
    • Department of Neurological Surgery, Rush University Medical Center, Chicago, Illinois, USA.
    • World Neurosurg. 2022 Mar 1; 159: e1-e7.

    ObjectiveExpandable transforaminal lumbar interbody fusion (TLIF) cages capable of multidirectional in situ expansion have gained popularity as they increase axial surface area for fusion and may enhance lordotic correction through a traditional minimally invasive surgery (MIS) surgical corridor. We evaluated and compared the radiographic and clinical outcomes between a novel expandable versus static minimally invasive surgery TLIF cage for the treatment of degenerative disk disease.MethodsA single-center retrospective review of 120 consecutive adult patients undergoing 1- or 2-level MIS TLIF with an expandable (n = 60) or static cage was performed between 2015 and 2019. Preoperative and 1-year postoperative radiographic and clinical outcomes were assessed by upright flexion/extension radiographs and serial confidential surveys.ResultsOne-hundred twenty patients (mean age 63.5 years, 60.0% female) undergoing 1- and 2-level MIS TLIF met inclusion criteria. A statistically significant reduction of spondylolisthesis, restoration of foraminal height as well as anterior and posterior disk height was achieved in both cohorts, however was greater in the expandable cage cohort (ECC) (all P < 0.05). Comparable rates of fusion, 93% and 91%, were observed in the ECC and static cage cohort. A significant reduction in Numeric Pain Rating Scale back and Oswestry Disability Index scores were observed in both cohorts but were more pronounced in the ECC (5.9 ± 2.4 to 2.2 ± 1.9 and 37.3 ± 16.2 to 17.1 ± 15.2) versus static cage cohort (6.2 ± 2.8 to 3.2 ± 2.5 and 41.8 ± 16.1 to 24.3 ± 17.5) (P < 0.05). One instance of cage migration requiring reoperation occurred in the ECC.ConclusionsTaken together, these radiographic and clinical findings suggest an expandable cage placed through an MIS corridor represents a safe, equitable, and efficacious alternative to a static TLIF in adults with degenerative lumbar pathology.Copyright © 2021 Elsevier Inc. All rights reserved.

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