Expandable Cage Technology—Transforaminal, Anterior, and Lateral Lumbar Interbody Fusion

Abstract

This review of the literature will focus on the indications, surgical techniques, and outcomes for expandable transforaminal lumbar interbody fusion (TLIF), anterior lumbar interbody fusion (ALIF), and lateral lumbar interbody fusion (LLIF) operations. The expandable TLIF cage has become a workhorse for common degenerative pathology, whereas expandable ALIF cages carry the promise of greater lordotic correction while evading the diseased posterior elements. Expandable LLIF cages call upon minimally invasive techniques for a retroperitoneal, transpsoas approach to the disc space, obviating the need for an access surgeon and decreasing risk of injury to the critical neurovascular structures. Nuances between expandable and static cages for all 3 TLIF, ALIF, and LLIF operations are discussed in this review.

Full Endoscopic Posterolateral Transarticular Lumbar Interbody Fusion Using Transparent Plastic Working Tubes: Technical Note and Preliminary Clinical Results

“…Furthermore, endoscopic TLIF can be distinguished into three surgical techniques based on the type of the endoscope used (percutaneous endoscopic TLIF with a working channel, biportal endoscopic TLIF, microendoscopic TLIF, and Full-Endoscopic Oblique Lateral Lumbar Interbody Fusion) ( 14 ). Almost all these studies mentioned the problem of the steep and potentially dangerous learning curve ( 11 , 15 ); the possible reason includes (1) the anatomy of the intervertebral foramina under the endoscope is unfamiliar ( 16 ), and the risk of exiting nerve root injury is high, especially during the placement of the cage, so there are some reports in the literature about expandable mesh interbody fusion cage ( 4 , 17 ); its main advantages appear to be decreased anatomical disruption during delivery and deployment. The problem is that this will increase the financial burden on the patients, and a larger number of patients and further long-term follow-up are warranted ( 18 ).…”

Recent advancement in finite element analysis of spinal interbody cages: A review

“…At this point, the use of finite element models to somewhat simplify and idealize the problem is frequently a strength, allowing new designs to be thoroughly “tested” before a cage is even manufactured, bio-mechanical responses and fusion processes that cannot easily be experimented upon in vivo to be examined, and “diagnosis” to be performed ( Fagan et al, 2002 ). In recent years, many reviews have summarized and studied the materials and design of ICs, as well as the corresponding fusion techniques ( Phan and Mobbs, 2016 ; Enders et al, 2020 ; Gou et al, 2021 ; Macki et al, 2021 ; Tan et al, 2021 ). However, few reviews concentrate on the FEA of ICs.…”

Does the application of expandable cages in TLIF provide improved clinical and radiological results compared to static cages? A meta-analysis

“…Expandable cages were designed to alleviate these difficulties by permitting insertion in a collapsed state and expansion in situ , enhancing the ease of insertion, and reducing iatrogenic endplate damage caused by impaction ( 11 , 12 ). The design of this device may reduce neural retraction, endplate injury, implant subsidence and/or migration, and allow expansion in the interbody space, maximizing the disc space height ( 13 ). However, increased expansion may lead to endplate damage and subsidence, and reduced fusion rates ( 14 ).…”