Expandable cages increase the risk of intraoperative subsidence but do not improve perioperative outcomes in single level transforaminal lumbar interbody fusion

Stickley, Carolyn; Philipp, Travis; Wang, Erik; Zhong, Jack; Balouch, Eaman; O'Malley, Nicholas; León, Carlos; Maglaras, Constance; Manning, Jordan H.; Varlotta, Christopher; Buckland, Aaron J.

doi:10.1016/j.spinee.2020.08.019

Cited by 26 publications

(16 citation statements)

References 20 publications

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“…In our study, we also found that MIS-TLIF with expandable cage did not significantly improve SL or LL in patients with osteoporosis compared with static cage. Although several authors have described that expandable cages increase the risk of intraoperative settlement [22,23], we found that the use of expandable cages may help to reduce the risk of intraoperative settlement in patients with osteoporosis. The endplate is a cortical bone covering the upper and lower surfaces of the vertebral body.…”

Section: Discussionmentioning

confidence: 61%

Comparison of Long-Term Efficacy of MIS-TLIF Intraoperative Implants in Patients with Osteoporosis

Liu

et al. 2022

Computational and Mathematical Methods in Medicine

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Osteoporosis and degenerative spinal disease are still an unsolvable surgical problem. It is still difficult to solve the complications related to postoperative osteoporosis, such as cage subsidence, displacement, and retraction. Expandable interbody cage is a recent innovation and an increasingly popular alternative to standard static cage. However, the clinical efficacy of MIS-TLIF combined with expandable cage for the treatment of osteoporosis has limited reports. The purpose of this paper was to analyze the efficacy of MIS-TLIF with expandable cage in patients with degenerative lumbar disease with osteoporosis. Patients with osteoporosis who received single-level MIS-TLIF and were followed up for at least 1 year were included. The outcome measures are as follows: clinical features, perioperative period, and neurological complications. JOA score and VAS pain score were used to analyze the improvement of patients’ function. Imaging analysis included segmental lordosis (SL), lumbar lordosis (LL), intervertebral disc height (DH), and the ratio of cage height to preoperative DH (RCD). The final data analysis included 284 patients with osteoporosis. 178 patients used static cages, and 106 patients used expandable cages. There was no significant difference in baseline characteristics, surgical indexes, and JOA and VAS scores between the two groups. There was no difference in SL or LL between static group and expandable group. There was no significant difference in preoperative DH between the two groups. The RCD in the expansion group was significantly lower than that in the static group. The intraoperative and postoperative sedimentation rate in the static group was significantly higher than that in the expandable group. The use of expandable cages in MIS-TLIF has shown good results for the treatment of degenerative lumbar diseases with osteoporosis. Through appropriate surgical techniques, the expandable cage can reduce the risk of cage sinking.

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Section: Discussionmentioning

confidence: 61%

Comparison of Long-Term Efficacy of MIS-TLIF Intraoperative Implants in Patients with Osteoporosis

Liu

et al. 2022

Computational and Mathematical Methods in Medicine

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“…Although MIS-TLIF is a common procedure, differences in surgical technique and cage preferences have made it difficult to determine if static or expandable cages are superior. Previous studies have demonstrated mixed results regarding postoperative radiographic and clinical out- comes after utilization of expandable compared to static cages [9][10][11][12][13]20]. According to some studies, expandable cages are associated with an increased risk of intraoperative endplate subsidence due to the high expansion forces applied by expandable devices' relatively small footprint [14,15,21].…”

Section: Discussionmentioning

confidence: 99%

“…A large meta-analysis that evaluated clinical and radiographic outcomes of both cage types across 12 studies identified a significant increase in mean disk height with static cages [ 12 ]. Two additional studies found no significant differences in disk height with expandable cages [ 20 , 24 ]. A recent multi-surgeon review found no significant differences in mean disk height or anterior and posterior disk heights change between cage types [ 20 ].…”

Section: Discussionmentioning

confidence: 99%

“…Two additional studies found no significant differences in disk height with expandable cages [ 20 , 24 ]. A recent multi-surgeon review found no significant differences in mean disk height or anterior and posterior disk heights change between cage types [ 20 ]. Additionally, they noted that cage design did not significantly affect changes in segmental lordosis ( p =0.237) [ 20 ].…”

Section: Discussionmentioning

confidence: 99%

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Static versus Expandable Interbody Fusion Devices: A Comparison of 1-Year Clinical and Radiographic Outcomes in Minimally Invasive Transforaminal Lumbar Interbody Fusion

et al. 2023

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To compare the radiographic and clinical outcomes of static versus expandable interbody cages in transforaminal lumbar interbody fusion using minimally invasive surgery (MIS-TLIF). Overview of Literature: Expandable interbody cages may potentially improve radiographic and clinical outcomes following MIS-TLIF compared to static pages, but at a potentially higher cost and increased rates of subsidence. Methods: A retrospective chart review of 1-and 2-level MIS-TLIFs performed from 2014 to 2020 was reviewed. Radiographic measurements were obtained preoperatively, 6 weeks postoperatively, and at final follow-up. Patient-reported outcome measures (PROMs) including the Oswestry Disability Index, Visual Analog Scale (VAS) back, and VAS leg were evaluated. Multivariate linear regression analysis determined the effect of cage type on the change in PROMs, controlling for demographic characteristics. Alpha was set at 0.05. Results: A total of 221 patients underwent MIS-TLIF including 136 static and 85 expandable cages. Expandable cages had significantly greater anterior (static: 11.41 mm vs. expandable: 13.11 mm, p<0.001) and posterior disk heights (static: 7.22 mm vs. expandable: 8.11 mm, p<0.001) at 1-year follow-up. Expandable cages offered similar improvements in segmental lordosis at 6 weeks (static: 1.69° vs. expandable: 2.81°, p=0.243), but segmental lordosis was better maintained with expandable cages leading to significant differences at 1-year follow-up (static: 0.86° vs. expandable: 2.45°, p=0.001). No significant differences were noted in total complication (static: 12.5% vs. expandable: 16.5%, p=0.191) or cage subsidence rates (static: 19.7% vs. expandable: 22.4%, p=0.502) groups at 1-year follow-up. Conclusions: Expandable devices provide greater improvements in radiographic measurements including anterior disk height, posterior disk height, and segmental lordosis, but this did not lead to significant improvements in PROMs, complication rates, subsidence rates, or subsidence distance.

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“…In the process of implanting, NE-IFC will destroy the lateral surface of endplate and cortical bone because of striking hard, this may adversely affect the stability and fusion rate of the fusion device ( 7 ). Expandable interbody fusion devices (EXP-IFC) are a good option, as they collapse into the disc space to reduce damage to the upper and lower endplates, at the same time, it can reduce the amount of blood loss and become a less invasive alternative ( 8 , 9 ). ( Figure 1 ).…”

Section: Introductionmentioning

confidence: 99%

Comparison of the efficacy of expandable interbody fusion cage (EXP-IFC) and non-expandable interbody fusion cage (NE-IFC) in MIS-TLIF for lumbar degenerative diseases: A systematic retrospective study on 62 patients

Chen

Li²,

Wang³

et al. 2022

Front. Surg.

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ObjectivesTo investigate the clinical and radiographic outcomes of EXP-IFC in single-level MIS-TLIF.MethodsThis study included patients aged ≥18 years who received a single-level MIS-TLIF procedure with at least 1 year of follow-up. Outcome measures: clinical features, preoperative and neurological complications. Imaging analysis included disc height (DH) restoration, surgical and contralateral side foraminal height (FH), lumbar lordosis angle (LL), segmental lordosis (SL). Visual analog scale (VAS) score for low back pain (VAS-LBP) and leg pain (VAS-LP), Oswestry Disability Index (ODI) and Japanese Orthopaedic Association (JOA) score were used to evaluate clinical outcomes. Statistical analysis was performed using independent sample t-test and sample t-test. The significance was set to p < 0.05 in univariate analysis.ResultsA total of 62 patients undergoing single level MIS-TLIFs between January 2017 and January 2019 were included, with 32 NE-IFC 46.9% female, mean age 54.86 ± 11.65, mean body mass index (BMI) 24.59 ± 3.63) and 30 EXP (40% female, mean age 58.32 ± 12.99, mean BMI 24.45 ± 2.76) with no significant differences in demographics. There were no significant differences between two groups in Operative time (OT), Estimated blood loss (EBL) and Length of stay (LOS). No significant differences were found in VAS-LBP, VAS-LP, JOA and ODI in post-operation and the last follow-up between the two groups. The imaging outcome demonstrated that the mean increase in DH was significantly greater for the patients with EXP-IFC than those with NE-IFC group at 1 year follow-up (8.92 ± 0.51 mm EXP-IFC vs. 7.96 ± 0.96 mm NE-IFC, p < 0.001). The mean change in FH of operative and contralateral sides were observed to be significantly higher for the patients with EXP-IFC at 1 year follow-up (operative side:17.67 ± 2.29 mm EXP-IFC vs. 16.01 ± 2.73 mm NE-IFC, p = 0.042; contralateral side:17.32 ± 2.26 mm EXP-IFC vs. 16.10 ± 2.32 mm NE-IFC, p < 0.001), but changes in LL and SL were not significantly different. At the last follow-up, we did not find any significant difference in the fusion rate between the two groups.ConclusionOur results indicated that there may be no significant difference in short-term clinical outcomes between EXP-IFC and NE-IFC, but the use of EXP-IFC in MIS-TLIF can provide a significant restoration of disc height, and neural foraminal height compared to NE-IFC.

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Expandable cages increase the risk of intraoperative subsidence but do not improve perioperative outcomes in single level transforaminal lumbar interbody fusion

Cited by 26 publications

References 20 publications

Comparison of Long-Term Efficacy of MIS-TLIF Intraoperative Implants in Patients with Osteoporosis

Comparison of Long-Term Efficacy of MIS-TLIF Intraoperative Implants in Patients with Osteoporosis

Static versus Expandable Interbody Fusion Devices: A Comparison of 1-Year Clinical and Radiographic Outcomes in Minimally Invasive Transforaminal Lumbar Interbody Fusion

Comparison of the efficacy of expandable interbody fusion cage (EXP-IFC) and non-expandable interbody fusion cage (NE-IFC) in MIS-TLIF for lumbar degenerative diseases: A systematic retrospective study on 62 patients

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