Static Versus Expandable Devices Provide Similar Clinical Outcomes Following Minimally Invasive Transforaminal Lumbar Interbody Fusion

Abstract

Background: Few studies have analyzed differences in radiographic parameters and patient-reported outcomes (PROs) between expandable and static interbody devices in patients undergoing minimally invasive transforaminal lumbar interbody fusion (MIS TLIF). Questions/Purposes: To evaluate differences in radiographic parameters and PROs following MIS TLIF between static and expandable interbody devices. Methods: Patients undergoing primary, single-level MIS TLIF between 2014 and 2017 were retrospectively identified. Radiographic measurements including lumbar lordosis (LL), segmental lordosis (SL), disc height (DH), and foraminal height (FH) were performed on lateral radiographs before and after MIS TLIF with a static or expandable articulating interbody device. Radiographic outcomes and PROs were compared using paired and unpaired Student's t test. Results: Thirty patients received expandable interbody devices and 30 patients received static interbody devices. The expandable device cohort exhibited significantly greater improvement in DH and FH at final follow-up compared with those receiving a static device. Both device cohorts experienced significant improvements in PROs at 6 months post-operatively. Conclusion: MIS TLIF with an expandable interbody device led to a greater increase of DH and FH than with a static interbody device. Patients undergoing MIS TLIF can expect similar improvements in PROs whether receiving a static or an expandable interbody device. Further studies are required to better understand improvements in clinical outcomes afforded by expandable interbody devices.

Bidirectional Expandable Technology for Transforaminal or Posterior Lumbar Interbody Fusion: A Retrospective Analysis of Safety and Performance

“…These results were also commensurate with previous studies of expandable devices, which reported 12-month fusion rates ranging from 92% to 96%. 9,[21][22][23] Furthermore, Khechen et al 8 reported the proportions of patients reaching MCID for ODI, VAS leg, and VAS back at 6 months follow-up after TLIF with an expandable device to be 60%, 70%, and 67%, respectively, which were similar to the 58%, 71%, and 76% observed in the current study at a mean follow-up of 4.5 months. Similarly, Alimi et al 24 reported that 64%, 52%, and 52% of patients treated with an expandable device reached the MCID for ODI, VAS leg, and VAS back by an average of 19.3 months follow-up, but the MCID used for VAS was 3 points in that study.…”

“…es. 8,9,[21][22][23][24]30 Therefore, further prospective and randomized clinical trials are warranted to substantiate the positive, preliminary findings reported in the present study.…”

“…For example, Kim et al 27 and Stein et al 28 each observed postoperative retropulsion of a stackable PEEK layer used for expansion in 1 type of device. In studies 8,9,21,29 of other expandable PLIF and TLIF devices, no device-related complications were observed intraoperatively or postoperatively. Similarly, the current study revealed no device-related AEs.…”

“…Medial-lateral expansion may help to resist subsidence, whereas cranial-caudal expansion enables greater restoration of disc height and foraminal height than static (nonexpandable) spacers. 8,9 In situ device expansion may improve endplate contact while minimizing insertion forces and potential endplate damage, 10 which may help reduce the risk of spacer migration or subsidence. 11 These expandable designs are compatible with minimally invasive surgical techniques, which are well established and continue to gain popularity in spinal surgery.…”

Minimally Invasive Transforaminal Lumbar Interbody Fusion and Restoration of Segmental and Lumbar Lordosis

“…Широко описаны варианты техник минимально инвазивного TLIF [7][8][9][10] и обозначены их преимущества, такие как меньшая раневая площадь, малый объем кровопотери, быстрое заживление послеоперационной раны, низкая частота осложнений, меньшая выраженность болевого синдрома в послеоперационном периоде и, как следствие, низкая потребность в анальгетиках, ранние активизация пациентов и начало восстановительного периода, сокращение времени пребывания в стационаре и скорое возвращение к активной деятельности [11][12][13].…”