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Technical feasibility and early clinical outcome of biportal endoscopic transforaminal lumbar interbody fusion using larger cage – Lumbar Fusion

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The article discusses the use of larger cages in transforaminal lumbar interbody fusion with biportal endoscopic guidance (BE-TLIF). The study enrolled patients who underwent single-level BE-TLIF using larger cages designed for oblique lumbar interbody fusion (OLIF). The clinical outcomes and technical feasibility of this approach were analyzed, including the improvement in Visual Analog Scale (VAS) scores for back and leg pain, Oswestry Disability Index (ODI) scores, and the evaluation of patients using the modified Macnab criteria. The study found that the use of larger cages in BE-TLIF resulted in positive clinical outcomes without complications such as subsidence. The authors concluded that a larger cage may be advantageous in terms of interbody fusion and subsidence in BE-TLIF procedures

Summarised by Mr Mo Akmal – Lead Spinal Surgeon
The London Spine Unit : best situated spinal hospital on Harley Street UK

Published article

CONCLUSION: BE-TLIF using a larger cage was safely performed without risk of subsidence during 1-year follow-up. A cage with a larger footprint may be advantageous in BE-TLIF in the aspect of interbody fusion and subsidence.

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World Neurosurg. 2023 Aug 3:S1878-8750(23)01089-6. doi: 10.1016/j.wneu.2023.07.141. Online ahead of print.ABSTRACTBACKGROUND: Transforaminal lumbar interbody fusion with biportal endoscopic guidance (BE-TLIF) has been previously reported with promising clinical results. However, complications such as delayed union or subsidence occurred as with open surgery. We assumed using larger cages would result in less occurrence of such complications. We,

World Neurosurg. 2023 Aug 3:S1878-8750(23)01089-6. doi: 10.1016/j.wneu.2023.07.141. Online ahead of print.

ABSTRACT

BACKGROUND: Transforaminal lumbar interbody fusion with biportal endoscopic guidance (BE-TLIF) has been previously reported with promising clinical results. However, complications such as delayed union or subsidence occurred as with open surgery. We assumed using larger cages would result in less occurrence of such complications. We aimed to analyze the clinical outcome and technical feasibility of BE-TLIF using larger cages, initially designed for oblique lumbar interbody fusion (OLIF).

METHOD: We enrolled cases that underwent single-level BE-TLIF between January 2021 and January 2022. Polyetheretherketone cages that were larger than the conventional size were used. Diagnoses were degenerative spondylolisthesis or isthmic spondylolisthesis. Visual Analog Scale (VAS) of the back and leg, and Oswestry Disability Index (ODI) were collected perioperatively. Modified Macnab criteria were used to evaluate the patients at the final follow-up. Radiological outcome of interbody fusion rate and perioperative complications were analyzed.

RESULT: A total of thirty-five cases were included in this study. The mean age was 67.5±8.4 and consisted of thirteen male patients, and the mean follow-up duration was 18.3±3.7 months. The majority (32/35, 91.3%) of the index level was located within the lower lumbar region, L4-S1. ODI scores improved from 65.4±5.4 preoperatively to 15.4±6.1 at the final follow-up (p<0.001). VAS scores of the leg decreased from 7.9±1.5 to 1.7±1.5 at the final follow-up (p<0.001). Per the modified Macnab criteria on the final follow-up, 94% of the patients reported good/excellent. The 94.2% of the patients showed fusion grade I and II at the one-year follow-up. No patient showed subsidence or other postoperative complication.

CONCLUSION: BE-TLIF using a larger cage was safely performed without risk of subsidence during 1-year follow-up. A cage with a larger footprint may be advantageous in BE-TLIF in the aspect of interbody fusion and subsidence.

PMID:37543195 | DOI:10.1016/j.wneu.2023.07.141

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Technical feasibility and early clinical outcome of biportal endoscopic transforaminal lumbar interbody fusion using larger cage

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World Neurosurg. 2023 Aug 3:S1878-8750(23)01089-6. doi: 10.1016/j.wneu.2023.07.141. Online ahead of print.ABSTRACTBACKGROUND: Transforaminal lumbar interbody fusion with biportal endoscopic guidance (BE-TLIF) has been previously reported with promising clinical results. However, complications such as delayed union or subsidence occurred as with open surgery. We assumed using larger cages would result in less occurrence of such complications. We
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