Additional sagittal correction can be obtained when using an expandable titanium interbody device in lumbar Smith-Peterson osteotomies: a biomechanical study

Study Design Retrospective cohort study. Objective To compare the clinical and radiographic outcomes of transforaminal lumbar interbody fusion (TLIF) and posterolateral lumbar fusion (PLF) in the treatment of degenerative spondylolisthesis. Methods This study compared 24 patients undergoing TLIF and 32 patients undergoing PLF with instrumentation. The clinical outcomes were assessed by visual analog scale (VAS) for low back pain and leg pain, physical component summary (PCS) of the 12-item Short-Form Health Survey, and the Oswestry Disability Index (ODI). Radiographic parameters included slippage of the vertebra, local disk lordosis, the anterior and posterior disk height, lumbar lordosis, and pelvic parameters. Results The improvement of VAS of leg pain was significantly greater in TLIF than in PLF unilaterally (3.4 versus 1.0; p = 0.02). The improvement of VAS of low back pain was significantly greater in TLIF than in PLF (3.8 versus 2.2; p = 0.02). However, there was no significant difference in improvement of ODI or PCS between TLIF and PLF. Reduction of slippage and the postoperative disk height was significantly greater in TLIF than in PLF. There was no significant difference in local disk lordosis, lumbar lordosis, or pelvic parameters. The fusion rate was 96% in TLIF and 84% in PLF (p = 0.3). There was no significant difference in fusion rate, estimated blood loss, adjacent segmental degeneration, or complication rate. Conclusions TLIF was superior to PLF in reduction of slippage and restoring disk height and might provide better improvement of leg pain. However, the health-related outcomes were not significantly different between the two procedures.

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“…A newly invented expandable TLIF cage might be a future option to simultaneously gain lordosis and disk height. 24 …”

Section: Discussionmentioning

confidence: 99%

Does Transforaminal Lumbar Interbody Fusion Have Advantages over Posterolateral Lumbar Fusion for Degenerative Spondylolisthesis?

Fujimori

Schairer

et al. 2014

Global Spine Journal

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“…11 Additionally, there may be better disc height restoration and sagittal alignment correction compared with static spacers; however, studies comparing static spacers with expandable spacers are lacking. [12][13][14][15][16][17] The importance of restoring radiographic parameters for improved functional outcomes has been well established. [18][19][20] The goal of this study is to compare the surgical outcomes of patients treated with expandable spacers after an MIS LLIF to those who were treated with static spacers.…”

Section: Introductionmentioning

confidence: 99%

Comparative Effectiveness of Expandable Versus Static Interbody Spacers via MIS LLIF: A 2-Year Radiographic and Clinical Outcomes Study

Frisch

Huang

et al. 2019

Global Spine Journal

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Study Design: Retrospective cohort study. Objective: The purpose of this study is to compare the radiographic and clinical outcomes of expandable interbody spacers to static interbody spacers. Methods: This is a retrospective, institutional review board–exempt chart review of 62 consecutive patients diagnosed with degenerative disc disease who underwent minimally invasive spine surgery lateral lumbar interbody fusion (MIS LLIF) using static or expandable spacers. There were 27 patients treated with static spacers, and 35 with expandable spacers. Radiographic and clinical functional outcomes were collected. Statistical results were significant if P < .05. Results: Mean improvement in visual analogue scale back and leg pain scores was significantly greater in the expandable group compared to the static group at 6 and 24 months by 42.3% and 63.8%, respectively ( P < .05). Average improvement in Oswestry Disability Index scores was significantly greater in the expandable group than the static group at 3, 6, 12, and 24 months by 28%, 44%, 59%, 53%, and 89%, respectively ( P < .05). For disc height, the mean improvement from baseline to 24 months was greater in the static group compared to the expandable group ( P < .05). Implant subsidence was significantly greater in the static group (16.1%, 5/31 levels) compared with the expandable group (6.7%, 3/45 levels; P < .05). Conclusions: This study showed positive clinical and radiographic outcomes for patients who underwent MIS LLIF with expandable spacers compared to those with static spacers. Sagittal correction and pain relief was achieved and maintained through 24-month follow-up. The expandable group had a lower subsidence rate than the static group.

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“…Subsidence was found in 9 of 21 interbody levels because of poor bone quality. [ 19 ] Alimi et al . studied 49 patients with polyetheretherketone implants who underwent TLIF surgery and found no significant changes in SL and LL.…”

Section: Discussionmentioning

confidence: 99%

Transforaminal lumbar interbody fusion with expandable cages: Radiological and clinical results of banana-shaped and straight implants

Tassemeier

Haversath

Jäger

2018

J Craniovert Jun Spine

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Purpose:Expandable titanium transforaminal lumbar interbody fusion (TLIF) devices are a relatively new group of implants allowing restoration of lumbar lordosis (LL) and thus improvement of sagittal alignment. The purpose of our study is to compare clinical and radiological results of two different expandable TLIF devices.Materials and Methods:In a retrospective study, patients who underwent TLIF surgery with a banana-shaped or straight TLIF cage in our spine center were analyzed. Primary outcome was change of disc height (DH), segmental lordosis angle (SLA), and lumbar lordotic angle (LLA). Moreover, basic patients parameters and cage subsidence were evaluated.Results:Sixty-one patients were studied (33 banana-shaped and 28 straight cages). DH changed in the banana group from 4.8 mm (standard deviation SD 2.5) to 10.4 (SD 2.4) and in the straight cage group from 6.2 mm (SD 2.5) to 9.6 mm (SD 1.7). The difference was statistically significant (P = 0.03). In addition, SLA correction was higher in the banana group with 5.8° (SD 5.0)–3.7° (SD 3.6), but not significant. LLA improved in the straight group with 5.2 (SD 6.4) compared to 3.7° (SD 5.8) in the banana group. We found subsidence in four patients (6.6%) in the banana-shaped group and nine cases (14.8%) in the other group.Conclusions:Expandable titanium implants show similar improvements in restoring segmental and global lordosis. Banana-shaped expandable cages offer higher potency restoring the intervertebral DH and show less rates of subsidence compared to straight expandable cages.

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Additional sagittal correction can be obtained when using an expandable titanium interbody device in lumbar Smith-Peterson osteotomies: a biomechanical study

Cited by 20 publications

References 17 publications

Does Transforaminal Lumbar Interbody Fusion Have Advantages over Posterolateral Lumbar Fusion for Degenerative Spondylolisthesis?

Does Transforaminal Lumbar Interbody Fusion Have Advantages over Posterolateral Lumbar Fusion for Degenerative Spondylolisthesis?

Comparative Effectiveness of Expandable Versus Static Interbody Spacers via MIS LLIF: A 2-Year Radiographic and Clinical Outcomes Study

Transforaminal lumbar interbody fusion with expandable cages: Radiological and clinical results of banana-shaped and straight implants

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