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Expandable cages that expand both height and lordosis provide improved immediate effect on sagittal alignment and short-term clinical outcomes following minimally invasive transforaminal lumbar interbody fusion (MIS TLIF) – Lumbar Fusion

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The article discusses the use of expandable cages in minimally invasive transforaminal lumbar interbody fusion (MIS TLIF) surgery to restore lordotic alignment in the spine. The study compared two types of expandable cages, one designed to increase disc height and the other designed to increase both height and lordosis. Results showed that the group with cages designed for both height and lordosis had superior improvement in segmental lordosis and disc angle compared to the group with cages designed only for height. While both groups showed favorable outcomes, it is important to avoid excessive force during surgery to prevent complications such as subsidence. Long-term follow-up is necessary to assess the clinical outcome, fusion rate, and maintenance of sagittal alignment

Summarised by Mr Mo Akmal – Lead Spinal Surgeon
The London Spine Unit : most advanced day surgery unit in London

Published article

S: Expandable cages with a design specifically aimed at increasing lordotic angle can provide favorable outcomes and effectively improve immediate sagittal alignment following MIS TLIF, compared to conventional cages that only increase in height. However, regardless of the type of expandable cage used, it is crucial to avoid applying excessive force to achieve greater disc height or lordosis, as this may contribute to subsidence and a possible reduction in lordotic alignment…

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J Spine Surg. 2024 Mar 20;10(1):55-67. doi: 10.21037/jss-23-106. Epub 2024 Mar 15. ABSTRACT BACKGROUND: Failure to restore lordotic alignment is not an uncommon problem following minimally invasive transforaminal lumbar interbody fusion (MIS TLIF), even with expandable cages that increase disc height. This study aims to investigate the effect of the expandable cage that is specifically,

J Spine Surg. 2024 Mar 20;10(1):55-67. doi: 10.21037/jss-23-106. Epub 2024 Mar 15.

ABSTRACT

BACKGROUND: Failure to restore lordotic alignment is not an uncommon problem following minimally invasive transforaminal lumbar interbody fusion (MIS TLIF), even with expandable cages that increase disc height. This study aims to investigate the effect of the expandable cage that is specifically designed to expand both height and lordosis. We evaluated the outcomes of MIS TLIF in restoring immediate postoperative sagittal alignment by comparing two different types of expandable cages. One cage is designed to solely increase disc height (Group H), while the other can expand both height and lordosis (Group HL).

METHODS: Patients undergoing MIS TLIF using expandable cages were retrospectively reviewed, including 40 cases in Group H and 109 cases in Group HL. Visual analog scores of back and leg pain, and Oswestry disability index were collected. Disc height, disc angle, and sagittal alignment were measured. Complications were recorded, including early subsidence which was evaluated with computed tomography.

RESULTS: Clinical and radiographic outcomes significantly improved in both groups postoperatively. Group HL showed superior improvement in segmental lordosis (4.4°±3.5° vs. 2.1°±4.8°, P=0.01) and disc angle (6.3°±3.8 vs. 2.2°±4.3°, P<0.001) compared to Group H. Overall incidence of early subsidence was 23.3%, predominantly observed during initial cases as part of the learning curve, but decreased to 18% after completion of the first 20 cases.

S: Expandable cages with a design specifically aimed at increasing lordotic angle can provide favorable outcomes and effectively improve immediate sagittal alignment following MIS TLIF, compared to conventional cages that only increase in height. However, regardless of the type of expandable cage used, it is crucial to avoid applying excessive force to achieve greater disc height or lordosis, as this may contribute to subsidence and a possible reduction in lordotic alignment restoration. Long-term results are needed to evaluate the clinical outcome, fusion rate, and maintenance of the sagittal alignment.

PMID:38567017 | PMC:PMC10982918 | DOI:10.21037/jss-23-106

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Expandable cages that expand both height and lordosis provide improved immediate effect on sagittal alignment and short-term clinical outcomes following minimally invasive transforaminal lumbar interbody fusion (MIS TLIF)

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J Spine Surg. 2024 Mar 20;10(1):55-67. doi: 10.21037/jss-23-106. Epub 2024 Mar 15. ABSTRACT BACKGROUND: Failure to restore lordotic alignment is not an uncommon problem following minimally invasive transforaminal lumbar interbody fusion (MIS TLIF), even with expandable cages that increase disc height. This study aims to investigate the effect of the expandable cage that is specifically

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