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Transforaminal lumbar interbody fusion with a tantalum cage: lumbar lordosis redistribution and sacral slope restoration with a modified posterior technique – Lumbar Spinal Stenosis

This article discusses a study that evaluated the use of tantalum cages in a modified transforaminal lumbar interbody fusion (TLIF) technique. TLIF is a common procedure in spine surgery, and using tantalum cages can reduce the risk of nerve damage. The study retrospectively analyzed 105 patients who underwent the modified TLIF approach and assessed clinical outcomes and lumbar lordosis. The results showed excellent clinical results with a low failure rate. There was a significant redistribution of lumbar lordosis, indicating improved spinal alignment. The study concludes that the modified TLIF technique with tantalum cages is a valid surgical solution for achieving solid arthrodesis and restoring correct lumbar lordosis while reducing complications and failures

Summarised by Mr Mo Akmal – Lead Spinal Surgeon
The London Spine Unit : most established spine centre on Harley Street UK

Published article

CONCLUSION: Thanks to the properties of tantalum, our modified single-portal TLIF technique is a valid surgical solution to obtain a solid arthrodesis and restore the correct lumbar lordosis distribution while reducing neurological complications and the number of failures.

Lumbar Decompression Surgery Expert. Best Spinal Surgeon UK
J Orthop Traumatol. 2023 Dec 13;24(1):62. doi: 10.1186/s10195-023-00741-3.ABSTRACTBACKGROUND: Transforaminal lumbar interbody fusion (TLIF), a commonly used procedure in spine surgery, has the advantage of a lower incidence of nerve lesions compared to the posterior lumbar interbody fusion (PLIF) technique. The intersomatic arthrodesis has always been carried out with a single tantalum cage normally used for,

J Orthop Traumatol. 2023 Dec 13;24(1):62. doi: 10.1186/s10195-023-00741-3.

ABSTRACT

BACKGROUND: Transforaminal lumbar interbody fusion (TLIF), a commonly used procedure in spine surgery, has the advantage of a lower incidence of nerve lesions compared to the posterior lumbar interbody fusion (PLIF) technique. The intersomatic arthrodesis has always been carried out with a single tantalum cage normally used for PLIF. Tantalum is a metal that is particularly used in orthopedic surgery. It has a modulus of elasticity similar to marrow and leads to high primary stability of the implant.

MATERIALS AND METHODS: Our study was a retrospective monocentric observational study evaluating clinical and radiological outcomes of tantalum cages in a modified TLIF technique with posterior instrumentation and autologous and/or homologous posterolateral bone grafting. The aim of the study was to evaluate clinical outcomes and the increase in or redistribution of lumbar lordosis. The intersomatic arthrodesis was always carried out with a single tantalum cage normally used for PLIF to reduce the neurological risk. We retrospectively studied 105 patients who were treated with a modified unilateral TLIF approach by two surgeons between 2013 and 2018. We evaluated the Oswestry Disability Index (ODI), Visual Analogue Scale (VAS) for back pain, global lumbar lordosis, lordosis of L4-sacrum, segmental lordosis of functional motion units that underwent arthrodesis, pelvic tilt, pelvic incidence, and the sacral slope in 77 patients. All patients were suffering from grade III or IV Pfirrmann, instability, or foraminal post-laminectomy stenosis and/or grade I-II degenerative spondylolisthesis or low-grade isthmic spondylolisthesis. They had no significant sagittal imbalance, with a sagittal vertical axis (SVA) of < 5 mm. The average follow-up duration was 30 months.

RESULTS: We achieved excellent clinical results, with only four cases of failure (5.2%). Moreover, we noticed a statistically significant redistribution of lumbar lordosis, with an average percentage increase in L4-S1 lordosis equal to 19.9% (P < 0.001), an average increase in the L4-S1/Lumbar lordosis (LL) ratio from 0.53 to 0.63 (P < 0.001), and a mean percentage increase in sacral slope equal to 7.6% (P < 0.001).

CONCLUSION: Thanks to the properties of tantalum, our modified single-portal TLIF technique is a valid surgical solution to obtain a solid arthrodesis and restore the correct lumbar lordosis distribution while reducing neurological complications and the number of failures.

LEVEL OF EVIDENCE: 4 Trial registration statement: retrospective observational study, no trial registration.

PMID:38091159 | DOI:10.1186/s10195-023-00741-3

The London Spine Unit : most established spine centre on Harley Street UK

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Transforaminal lumbar interbody fusion with a tantalum cage: lumbar lordosis redistribution and sacral slope restoration with a modified posterior technique

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J Orthop Traumatol. 2023 Dec 13;24(1):62. doi: 10.1186/s10195-023-00741-3.ABSTRACTBACKGROUND: Transforaminal lumbar interbody fusion (TLIF), a commonly used procedure in spine surgery, has the advantage of a lower incidence of nerve lesions compared to the posterior lumbar interbody fusion (PLIF) technique. The intersomatic arthrodesis has always been carried out with a single tantalum cage normally used for
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