One and two level posterior lumbar interbody fusion (PLIF) using an expandable, stand-alone, interbody fusion device: a VariLift® case series

Abstract

Background: Surgical interventions such as posterior lumbar interbody fusion (PLIF) with and without posterior instrumentation are often employed in patients with degenerative spinal conditions that fail to respond to conservative medical management. The VariLift ® Interbody Fusion System was developed as a stand-alone solution to provide the benefits of an intervertebral fusion device without the requirement of supplemental pedicle screw fixation. Methods:In this retrospective case series, 25 patients underwent PLIF with a stand-alone VariLift ® expandable interbody fusion device without adjunctive pedicle screw fixation. There were 12 men and 13 women, with a mean age of 57.2 years (range, 33-83 years); single level in 18 patients, 2 levels in 7 patients.Back pain severity was reported as none, mild, moderate, severe and worst imaginable at baseline, 6 and 12 months. Preoperatively, 88% (22 of 25) of patients reported severe back pain.Results: All patients experienced symptomatic improvement and, by 12 months postoperatively, 71% (15 of 21) of patients reported only mild residual pain. Overall, pain scores improved significantly from baseline to 12 months (P=0.0002). There were no revision surgeries and fusion was achieved 12 of 13 patients (92%) who returned for a 12-month radiographic follow-up. There were three cases of intractable postsurgical pain which required extended hospitalization or pain management, one wound infection and one case of surgical site dehiscence, both treated and resolved during inpatient hospitalization. Conclusions:In this single-physician case series, the VariLift ® device used in single or two-level PLIF provided effective symptom relief and produced a high fusion rate without the need for supplemental fixation.

Thirty-Day Outcomes From Standalone Minimally Invasive Surgery-Transforaminal Lumbar Interbody Fusion Patients in an Ambulatory Surgery Center vs. Hospital Setting

“…The appropriately sized interbody device (VariLift-LX Wenzel Spine, Austin, USA) was then threaded into position with fluoroscopic guidance and expanded. The use of this expandable interbody has been described elsewhere and represents the only expandable interbody approved for standalone use by the US FDA [17][18][19][20][21][22]. After placement and expansion, the device was filled with morselized autograft from the harvested lamina mixed with allograft bone product or DBM if needed.…”

In Vitro Biomechanical and Fluoroscopic Study of a Continuously Expandable Interbody Spacer Concerning Its Role in Insertion Force and Segmental Kinematics

“…The aforementioned benefits of a vertically expandable posterior spacer do not negatively affect fusion rate and sagittal balance [ 27 , 28 ]. A retrospective analysis by Yee et al [ 28 ] (n=89 patients) observed similar lumbar lordosis results after 1 year between static and expandable TLIF spacers (2° versus 5°, respectively).…”

“…A retrospective analysis by Yee et al [ 28 ] (n=89 patients) observed similar lumbar lordosis results after 1 year between static and expandable TLIF spacers (2° versus 5°, respectively). Additionally, Barrett-Tuck et al [ 27 ] observed significantly improved pain scores following 12 months with solid fusion noted in 92.3% (n=12) of patients.…”

Can posterior stand-alone expandable cages safely restore lumbar lordosis? A minimum 5-year follow-up study

“…In the short term, patients who received a posterior expandable cage alone reported minor complications, such as posterior leg pain, infection, and wound problems. 27 However, long-term complications consisted of implant problems, especially subsidence, pseudoarthrosis, retropulsion, and cage breakage.…”