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Comparison of Surgical Outcomes between Lumbar Interbody Fusions using Expandable and Static Cages: A Systematic Review and Meta-Analysis – Lumbar Fusion

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The article presents a systematic review and meta-analysis that compared the surgical outcomes between the use of expandable cages and static cages for lumbar interbody fusion (LIF). Expandable cages, which allow for in-situ expansion, were developed to overcome complications associated with static cages such as endplate violation, graft subsidence, and nerve injury. The meta-analysis included 13 studies with 1,700 patients and found that expandable cages significantly increased the anterior disc height and segmental lordosis compared to static cages. However, there were no significant differences in the posterior disc height, lumbar lordosis, subsidence rate, back pain, leg pain, or Oswestry Disability Index (ODI) between the two groups. Therefore, the study concludes that expandable cages do not provide clear clinical benefits over static cages

Summarised by Mr Mo Akmal – Lead Spinal Surgeon
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Published article

CONCLUSION: Expandable cages show no clear clinical benefit over static cages.

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Spine J. 2023 Jul 18:S1529-9430(23)03279-5. doi: 10.1016/j.spinee.2023.07.012. Online ahead of print.ABSTRACTBACKGROUND: The use of static cages for lumbar interbody fusion (LIF) can cause complications such as endplate violation, graft subsidence, and nerve injury. Therefore, expandable cages that allow for in-situ expansion have been developed to overcome these problems. However, it remains uncertain whether expandable cages,

Spine J. 2023 Jul 18:S1529-9430(23)03279-5. doi: 10.1016/j.spinee.2023.07.012. Online ahead of print.

ABSTRACT

BACKGROUND: The use of static cages for lumbar interbody fusion (LIF) can cause complications such as endplate violation, graft subsidence, and nerve injury. Therefore, expandable cages that allow for in-situ expansion have been developed to overcome these problems. However, it remains uncertain whether expandable cages have better surgical outcomes than static cages do.

PURPOSE: We aimed to determine the effectiveness of expandable cages by analyzing studies that compared the surgical outcomes between the use of expandable cages and static cages.

STUDY DESIGN: a systematic review and meta-analysis METHODS: : The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used to conduct this meta-analysis and systematic review. The primary outcomes of this study were anterior disc height, posterior disc height, segmental lordosis (SL), lumbar lordosis (LL), subsidence rate, numeric rating scale (NRS) scores for back and leg pain, and Oswestry Disability Index (ODI).

RESULTS: Thirteen studies with 1,700 patients were included in the meta-analysis. Compared with static cages for LIFs, expandable cages significantly increased the anterior disc height (standardized mean difference 0.478, 95% confidence interval [CI] 0.088-0.867, p=0.0162) and segmental lordosis (sMD 0.307, 95% CI 0.159-0.454, p<0.0001). There were no significant differences in the posterior disc height, lumbar lordosis, subsidence rate, back pain, leg pain, or ODI between the two groups.

CONCLUSION: Expandable cages show no clear clinical benefit over static cages.

PMID:37473812 | DOI:10.1016/j.spinee.2023.07.012

The London Spine Unit : most specialised treatment facility in the world

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Comparison of Surgical Outcomes between Lumbar Interbody Fusions using Expandable and Static Cages: A Systematic Review and Meta-Analysis

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Spine J. 2023 Jul 18:S1529-9430(23)03279-5. doi: 10.1016/j.spinee.2023.07.012. Online ahead of print.ABSTRACTBACKGROUND: The use of static cages for lumbar interbody fusion (LIF) can cause complications such as endplate violation, graft subsidence, and nerve injury. Therefore, expandable cages that allow for in-situ expansion have been developed to overcome these problems. However, it remains uncertain whether expandable cages

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