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“Insert flipping technique:” An effective way of restoring segmental lordosis and disc height with tall bullet cages – Lumbar Fusion

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The article discusses a retrospective study that aims to describe a simple and effective technique for restoring intervertebral disc (IVD) height using the “Insert Flip Technique” of cage insertion. The study also demonstrates the effective restoration of IVD height and segmental lordosis (SL) and their impact on postoperative functional outcomes. The patients were assessed pre- and postoperatively for IVD height and SL, and were followed up at 6 weeks, 3 months, and 1 year for clinical assessment of back pain and leg pain. The results show significant improvement in postoperative Cobb’s angle and disc height with the use of tall bullet cages. The authors conclude that this modified technique allows for gaining lordosis with taller bullet cages in minimally invasive surgery transforaminal lumbar interbody fusion, reducing complications and the need for bone resection during cage insertion

Summarised by Mr Mo Akmal – Lead Spinal Surgeon
The London Spine Unit : most specialised day surgery spinal centre on Harley Street UK

Published article

: This modification of technique helped in gaining lordosis with taller bullet cages in minimally invasive surgery transforaminal lumbar interbody fusion with no/minimal complication and also reduced the need for bone resection during insertion of the cage.

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J Craniovertebr Junction Spine. 2023 Oct-Dec;14(4):412-417. doi: 10.4103/jcvjs.jcvjs_110_23. Epub 2023 Nov 29.ABSTRACTSTUDY DESIGN: The study design was a retrospective study.OBJECTIVE: The objectives of the present study are dual; to describe a simple and effective way of restoring intervertebral disc (IVD) height by the “Insert Flip Technique” of cage insertion and to demonstrate effective restoration of,

J Craniovertebr Junction Spine. 2023 Oct-Dec;14(4):412-417. doi: 10.4103/jcvjs.jcvjs_110_23. Epub 2023 Nov 29.

ABSTRACT

STUDY DESIGN: The study design was a retrospective study.

OBJECTIVE: The objectives of the present study are dual; to describe a simple and effective way of restoring intervertebral disc (IVD) height by the “Insert Flip Technique” of cage insertion and to demonstrate effective restoration of IVD height and segmental lordosis (SL) and their influence on the functional outcome postoperatively.

METHODS: IVD height and SL were recorded pre- and postoperatively. Each motion segment was instrumented with pedicle screws to allow segmental stabilization. Patients were called for follow-up at 6 weeks, 3 months, and 1 year postoperatively and were assessed clinically for back pain and leg pain (VAS and Oswestry Disability Index scores recorded).The bullet cages are designed such that they are lordotic in the superior-inferior plane and neutral in the mediolateral plane. Usually, the cage is inserted with superior and inferior surfaces of the cage impacting against superior and inferior end plates of the adjacent vertebral body. However, with the proposed technique, the cages were inserted such that the narrower mediolateral surfaces of the cage engaged with superior and inferior vertebral end plates. The cage was then flipped within the disc space such that the superior-inferior surfaces of the bullet cage impacted against the superior and inferior end plates of the vertebral body to create desired lordosis.

RESULTS: There was a significant improvement seen in the postoperative Cobb’s angle and disc height after placement of a tall bullet cage compared to the preoperative Cobb’s angle and disc height.

: This modification of technique helped in gaining lordosis with taller bullet cages in minimally invasive surgery transforaminal lumbar interbody fusion with no/minimal complication and also reduced the need for bone resection during insertion of the cage.

PMID:38268690 | PMC:PMC10805170 | DOI:10.4103/jcvjs.jcvjs_110_23

The London Spine Unit : most specialised day surgery spinal centre on Harley Street UK

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“Insert flipping technique:” An effective way of restoring segmental lordosis and disc height with tall bullet cages

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J Craniovertebr Junction Spine. 2023 Oct-Dec;14(4):412-417. doi: 10.4103/jcvjs.jcvjs_110_23. Epub 2023 Nov 29.ABSTRACTSTUDY DESIGN: The study design was a retrospective study.OBJECTIVE: The objectives of the present study are dual; to describe a simple and effective way of restoring intervertebral disc (IVD) height by the "Insert Flip Technique" of cage insertion and to demonstrate effective restoration of

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