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Utility of Expandable Interbody Cages in Open Transforaminal Interbody Fusions: A Comparison With Static Cages – Lumbar Fusion

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The article discusses the use of expandable interbody cages in open spinal fusions for adult spinal deformity (ASD) patients. Expandable cages are commonly used in minimally invasive fusions for their slim profile and ease of insertion, but their benefits in open surgery have not been widely explored. The study conducted a retrospective cohort study of patients who underwent an open transforaminal lumbar interbody fusion (TLIF) using expandable cages and compared the outcomes to those of patients treated with static cages from the literature. The results showed that expandable cages can effectively restore spinopelvic alignment in ASD patients and potentially improve patient outcomes compared to standard static cages. They also demonstrated similar changes in lumbar lordosis compared to certain static cages but better correction of lumbar lordosis compared to rectangular and 4° static cages. The study suggests that further exploration of the impact of open spinal fusions with expandable cages on outcomes should be conducted in other cohorts

Summarised by Mr Mo Akmal – Lead Spinal Surgeon
The London Spine Unit : most experienced treatment facility in the world

Published article

Background Expandable interbody cages, while popular in minimally invasive fusions due to their slim profile and increased ease of insertion, have not been widely explored in open surgery. The benefits of expandable cages may also extend to open fusions through their potential to achieve a greater restoration of lumbar lordosis while minimizing intraoperative complications. To highlight these benefits, we present a case series of adult spinal deformity (ASD) patients treated with an open…

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Cureus. 2023 Jun 11;15(6):e40262. doi: 10.7759/cureus.40262. eCollection 2023 Jun.ABSTRACTBackground Expandable interbody cages, while popular in minimally invasive fusions due to their slim profile and increased ease of insertion, have not been widely explored in open surgery. The benefits of expandable cages may also extend to open fusions through their potential to achieve a greater restoration,

Cureus. 2023 Jun 11;15(6):e40262. doi: 10.7759/cureus.40262. eCollection 2023 Jun.

ABSTRACT

Background Expandable interbody cages, while popular in minimally invasive fusions due to their slim profile and increased ease of insertion, have not been widely explored in open surgery. The benefits of expandable cages may also extend to open fusions through their potential to achieve a greater restoration of lumbar lordosis while minimizing intraoperative complications. To highlight these benefits, we present a case series of adult spinal deformity (ASD) patients treated with an open transforaminal lumbar interbody fusion (TLIF) using expandable cages and compare outcomes to those of patients treated with static cages from the literature. Methods A retrospective cohort study of patients who underwent a deformity correction procedure and TLIF with expandable interbody cages at Brigham and Women’s Hospital between 2018 and 2022 was conducted. Patient demographics, complications, and pre- and postoperative radiographic parameters of spinopelvic alignment were collected. A literature search was completed to identify studies employing static cages. T-tests were performed to compare postoperative changes in radiographic parameters by cage type. Results Forty-five patients (mean age of 62.6 years) with an average of 2.1 cages placed met the inclusion criteria. Patients experienced five intraoperative complications and 23 neurologic deficits (from minor to major), while nine patients required a revision operation. Lumbar lordosis increased by 9.8° ± 14.5° (p < 0.0001), the sagittal vertical axis (SVA) decreased by 25.5 mm ± 56.7 mm (p = 0.0048), and pelvic incidence-lumbar lordosis mismatch decreased by 13.3° ± 17.5° (p < 0.0001) with the use of expandable cages. Expandable cages yielded similar changes in lumbar lordosis to 15° and 8° cages but improved the lumbar lordosis generated from rectangular and 4° cages. When compared to static cages, expandable cages mildly reduced intraoperative complications. Conclusions Expandable interbody cages are an effective means of restoring spinopelvic alignment in ASD that have the potential to improve patient outcomes in open fusions compared to standard static cages. Especially when compared to rectangular and 4° static cages, expandable cages provide a clear benefit in the correction of lumbar lordosis. The impact of open spinal fusions with expandable cages on outcomes should continue to be explored in other cohorts.

PMID:37440805 | PMC:PMC10335839 | DOI:10.7759/cureus.40262

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Utility of Expandable Interbody Cages in Open Transforaminal Interbody Fusions: A Comparison With Static Cages

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Cureus. 2023 Jun 11;15(6):e40262. doi: 10.7759/cureus.40262. eCollection 2023 Jun.ABSTRACTBackground Expandable interbody cages, while popular in minimally invasive fusions due to their slim profile and increased ease of insertion, have not been widely explored in open surgery. The benefits of expandable cages may also extend to open fusions through their potential to achieve a greater restoration
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