Biplanar Expandable Cages for Transforaminal Lumbar Interbody Fusion Are Safe and Achieve Good 1-Year Clinical and Radiological Outcomes in an Asian Population

Overview

Journal Int J Spine Surg

Date 2023 Apr 19

PMID 37076255

Authors

David Shaoen Sim

Ayyadarshan Kasivishvanaath

Lei Jiang

Reuben Chee Cheong Soh

Zhixing Marcus Ling

Affiliations

Soon will be listed here.

Abstract

Background: This study investigated 1-year clinical and radiological outcomes of biplanar expandable (BE) cages following transforaminal lumbar interbody fusion (TLIF) in an Asian population.

Methods: A retrospective review was conducted of all consecutive patients who underwent TLIF with BE cages performed by 2 fellowship-trained spine surgeons from 2020 to 2021. Inclusion criteria included open or minimally invasive (MIS) TLIF, of up to 3 spinal segments, performed for treatment of degenerative disc disease, spondylolisthesis, or spinal stenosis. Patient-reported outcomes, including visual analog score (VAS) for back and lower limb pain, Oswestry Disability Index (ODI) and North American Spine Society neurogenic symptom score (NSS), and various radiographic parameters, were evaluated.

Results: A total of 23 patients underwent TLIF with BE cages with a follow-up duration of 1.25 years. Of those patients, 7 (30%) underwent 1-level TLIF, 12 (52%) underwent 2-level TLIF, and 4 (18%) underwent 3-level TLIF, with a total of 43 spinal segments fused. Four patients (17%) underwent MIS TLIF while 19 patients (83%) underwent open TLIF. VAS for back pain scores improved by 4.8 ± 3.4 ( < 0.001) from 6.5 ± 2.6 to 1.7 ± 2.2; VAS for lower limb pain scores improved by 5.2 ± 3.8 ( < 0.001) from 5.7 ± 3.4 to 0.5 ± 1.6; ODI scores improved by 29.0 ± 18.1 ( < 0.001) from 49.4 ± 15.1 to 20.4 ± 14.2; and NSS scores improved by 36.8 ± 22.1 ( < 0.001) from 53.3 ± 21.1 to 16.5 ± 19.8. Significant improvements in radiological parameters included increase in anterior disc height, posterior disc height, foraminal height, segmental lordosis, and lumbar lordosis. There were no implant-related complications, cage subsidence, cage migration, or revision surgery at 1 year.

Conclusions: TLIF performed with BE cages led to significantly improved patient-reported outcomes and radiographic parameters at 1 year and is safe for use in Asians.

Clinical Relevance: The results of this study support the effectiveness and safety of TLIF with biplanar expandable cages.

Level Of Evidence: 4:

References

Marchi L, Abdala N, Oliveira L, Amaral R, Coutinho E, Pimenta L . Radiographic and clinical evaluation of cage subsidence after stand-alone lateral interbody fusion. J Neurosurg Spine. 2013; 19(1):110-8. DOI: 10.3171/2013.4.SPINE12319. View

Sulaiman W, Singh M . Minimally invasive versus open transforaminal lumbar interbody fusion for degenerative spondylolisthesis grades 1-2: patient-reported clinical outcomes and cost-utility analysis. Ochsner J. 2014; 14(1):32-7. PMC: 3963049. View

Russo A, Schopler S, Stetzner K, Shirk T . Minimally invasive transforaminal lumbar interbody fusion with expandable articulating interbody spacers significantly improves radiographic outcomes compared to static interbody spacers. J Spine Surg. 2021; 7(3):300-309. PMC: 8511571. DOI: 10.21037/jss-20-630. View

Li H, Wang H, Zhu Y, Ding W, Wang Q . Incidence and risk factors of posterior cage migration following decompression and instrumented fusion for degenerative lumbar disorders. Medicine (Baltimore). 2017; 96(33):e7804. PMC: 5571712. DOI: 10.1097/MD.0000000000007804. View

Parisien A, Wai E, ElSayed M, Frei H . Subsidence of Spinal Fusion Cages: A Systematic Review. Int J Spine Surg. 2022; 16(6):1103-1118. PMC: 9807049. DOI: 10.14444/8363. View

Lewandrowski K, Ferrara L, Cheng B . Expandable Interbody Fusion Cages: An Editorial on the Surgeon's Perspective on Recent Technological Advances and Their Biomechanical Implications. Int J Spine Surg. 2020; 14(s3):S56-S62. PMC: 7735473. DOI: 10.14444/7127. View

Ostelo R, Deyo R, Stratford P, Waddell G, Croft P, Von Korff M . Interpreting change scores for pain and functional status in low back pain: towards international consensus regarding minimal important change. Spine (Phila Pa 1976). 2008; 33(1):90-4. DOI: 10.1097/BRS.0b013e31815e3a10. View

Hu Y, Niu C, Hsieh M, Tsai T, Chen W, Lai P . Cage positioning as a risk factor for posterior cage migration following transforaminal lumbar interbody fusion - an analysis of 953 cases. BMC Musculoskelet Disord. 2019; 20(1):260. PMC: 6542074. DOI: 10.1186/s12891-019-2630-0. View

Alvi M, Kurian S, Wahood W, Goyal A, Elder B, Bydon M . Assessing the Difference in Clinical and Radiologic Outcomes Between Expandable Cage and Nonexpandable Cage Among Patients Undergoing Minimally Invasive Transforaminal Interbody Fusion: A Systematic Review and Meta-Analysis. World Neurosurg. 2019; 127:596-606.e1. DOI: 10.1016/j.wneu.2019.03.284. View

10.

Khechen B, Haws B, Patel D, Yoo J, Guntin J, Cardinal K . Static Versus Expandable Devices Provide Similar Clinical Outcomes Following Minimally Invasive Transforaminal Lumbar Interbody Fusion. HSS J. 2020; 16(1):46-53. PMC: 6973784. DOI: 10.1007/s11420-019-09677-z. View

11.

Hsieh P, Koski T, OShaughnessy B, Sugrue P, Salehi S, Ondra S . Anterior lumbar interbody fusion in comparison with transforaminal lumbar interbody fusion: implications for the restoration of foraminal height, local disc angle, lumbar lordosis, and sagittal balance. J Neurosurg Spine. 2007; 7(4):379-86. DOI: 10.3171/SPI-07/10/379. View

12.

Hawasli A, Khalifeh J, Chatrath A, Yarbrough C, Ray W . Minimally invasive transforaminal lumbar interbody fusion with expandable versus static interbody devices: radiographic assessment of sagittal segmental and pelvic parameters. Neurosurg Focus. 2017; 43(2):E10. DOI: 10.3171/2017.5.FOCUS17197. View

13.

Tan L, Rivera J, Tan X, Le V, Khoo L, Berven S . Clinical and Radiographic Outcomes After Minimally Invasive Transforaminal Lumbar Interbody Fusion-Early Experience Using a Biplanar Expandable Cage for Lumbar Spondylolisthesis. Int J Spine Surg. 2020; 14(s3):S39-S44. PMC: 7735467. DOI: 10.14444/7125. View

14.

Boktor J, Pockett R, Verghese N . The expandable transforaminal lumbar interbody fusion - Two years follow-up. J Craniovertebr Junction Spine. 2018; 9(1):50-55. PMC: 5934965. DOI: 10.4103/jcvjs.JCVJS_21_18. View

15.

Coric D, Roybal R, Grubb M, Rossi V, Yu A, Swink I . Bidirectional Expandable Technology for Transforaminal or Posterior Lumbar Interbody Fusion: A Retrospective Analysis of Safety and Performance. Int J Spine Surg. 2020; 14(s3):S22-S30. PMC: 7735440. DOI: 10.14444/7123. View

16.

Cheng B, Swink I, Yusufbekov R, Birgelen M, Ferrara L, Lewandrowski K . Current Concepts of Contemporary Expandable Lumbar Interbody Fusion Cage Designs, Part 1: An Editorial on Their Biomechanical Characteristics. Int J Spine Surg. 2020; 14(s3):S63-S67. PMC: 7735463. DOI: 10.14444/7128. View

17.

Cheng B, Swink I, Yusufbekov R, Birgelen M, Ferrara L, Coric D . Current Concepts of Contemporary Expandable Lumbar Interbody Fusion Cage Designs, Part 2: Feasibility Assessment of an Endplate Conforming Bidirectional Expandable Interbody Cage. Int J Spine Surg. 2020; 14(s3):S68-S74. PMC: 7735472. DOI: 10.14444/7129. View