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

Tassemeier, Tjark; Haversath, Marcel; Jäger, Markus

doi:10.4103/jcvjs.jcvjs_56_18

Cited by 23 publications

(12 citation statements)

References 28 publications

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“…Violation of the end plates during decortication may expose the subchondral bone with vessel injury that is more likely to occur during open procedures in which the interspace is not directly visualized as during the endoscopic FELITF. The complications of root irritation (2%-3%), cage subsidence (4%-9%), and dysesthesia (6%-10%) are mentioned in various literature, [31][32][33] but none occurred in our patient except mild dysesthesia, and she recovered later.…”

Section: Discussionmentioning

confidence: 50%

Full Endoscopic Lumbar Transforaminal Interbody Fusion in DDD Lumbar Degenerative Disc Disease: A Latest Technique

et al. 2020

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Background: Lumbar interbody fusion has long been used in the treatment of degenerative disc disease. Lumbar spinal interbody fusion surgery traditionally is an open surgical technique. Although lumbar spinal interbody fusions using endoscopy have been reported, the endoscope was used partially for the interbody fusion. We are reporting a case where lumbar interbody fusion with discectomy was entirely done through direct visualization with the endoscope.Methods: We report a case of a 55-year-old woman who underwent the transforaminal percutaneous fullendoscopic lumbar interbody fusion technique (FELTIF) under continuous and direct visualization at the L5-S1 level. To facilitate the interbody fusion, a foraminoplasty with complete resection of the superior articular process (SAP) and a partial pediculectomy of the S1 pedicle was performed. End plate sparing decortication techniques were used under direct video endoscopic visualization. The cage and bone graft insertion occurred through the endoscopic working cannula, thereby protecting the retracted traversing and exiting nerve roots at the surgical level. Posterior supplemental fixation with percutaneous pedicle screws was performed to complete the circumferential fusion.Result: The VAS leg score was reduced to 2 from preoperative score of 7 and the VAS back score reduced 3 from preoperative score of 9. Her neurogenic symptom score improved from 8 before surgery to 1 at the last follow-up. The fusion is assessed by plain radiographs in follow up.Conclusions: We concluded that the insertion of an interbody fusion cage device directly through an endoscopic working cannula was technically feasible. Future research should focus on examining the clinical outcomes of this technique.Level of evidence: 4.

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Section: Discussionmentioning

confidence: 50%

Full Endoscopic Lumbar Transforaminal Interbody Fusion in DDD Lumbar Degenerative Disc Disease: A Latest Technique

et al. 2020

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“…The subsidence rate was 6.6% in patients who received the banana-shaped expandable cage and 14.8% in patients who received the static expandable group. 46 This study clearly highlights the importance of cage geometry and geometrical stiffness on clinical and radiographic outcome parameters.…”

Section: Static Versus Expandablementioning

confidence: 64%

“…Increase in posterior disc and foraminal height, restoration of lumbar lordosis, the absence of cage subsidence or endplate injury, along with bony bridging on advanced cross-sectional imaging studies including computed tomography are commonly investigated variables. Several clinical studies [1][2][3][4]6,16,22,23,[25][26][27][35][36][37][38][39][40][41][42][43][44][45][46][47][48][49] and a meta-analysis 10 on expandable lumbar interbody fusion cages have highlighted the use of these radiographic parameters and how they correlate to commonly used patient self-reported outcome measures.…”

Section: Measures Of Cliinical Successmentioning

confidence: 99%

Expandable Interbody Fusion Cages: An Editorial on the Surgeon's Perspective on Recent Technological Advances and Their Biomechanical Implications

Lewandrowski

Ferrara²,

Cheng

2020

Int J Spine Surg

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Background: Expandable cages have gone through several iterations since they first appeared on the market in the early 2000s. Their development was prompted by some common problems associated with static interbody cages, including migration, expulsion, dural or neural traction injury, and pseudarthrosis.Objective: To summarize current technological advances from earlier expandable lumbar interbody fusion devices to implants with vertical and medial-to-lateral expansion mechanisms.Methods: The authors review the currently available expandable cage designs, the incremental technological advances, and how these devices impact minimally invasive surgery interbody procedures and clinical outcomes. The strategic concepts intended to improve the minimally invasive application of expandable interbody fusion implants are reviewed from a surgeon's perspective in a clinical context to discuss how their use may improve patient outcomes.Conclusions: The geometrical configuration, effective stiffness of composite multi-material cage designs may impact the bone-implant contact area with the endplates. Hybridization strategies of expandable cage technology with modern minimally invasive and endoscopic spinal surgery techniques are presented by outlining their advantages and disadvantages.

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“…It should be noted that all expandable cages in our cohort were straight in shape. Bananashaped cages may reduce the rates of subsidence and improve anterior disk height as previously found in 1one retrospective 26 However, due to insufficient evidence on the effect of cage material and cage shape on postoperative radiographic parameters, future investigation comparing straight versus banana-shaped cages and PEEK versus titanium cages is warranted to understand their impact on radiographic outcomes. Our study did not find an association between cage positioning and sagittal alignment.…”

Section: Discussionmentioning

confidence: 76%

Does Interbody Cage Lordosis and Position Affect Radiographic Outcomes After Single-level Transforaminal Lumbar Interbody Fusion?

DiMaria

Karamian

Siegel

et al. 2022

Clinical Spine Surgery: A Spine Publication

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Study Design: This was a retrospective cohort study. Objective: The objective of this study was to determine if the degree of interbody cage lordosis and cage positioning are associated with changes in postoperative sagittal alignment after single-level transforaminal lumbar interbody fusion (TLIF). Summary of Background Data: Ideal sagittal alignment and lumbopelvic alignment have been shown to correlate with postoperative clinical outcomes. TLIF is one technique that may improve these parameters, but whether the amount of cage lordosis improves either segmental or lumbar lordosis (LL) is unknown. Methods: A retrospective review was performed on patients who underwent single-level TLIF with either a 5-degree or a 12-degree lordotic cage. LL, segmental lordosis (SL), disk height, center point ratio, cage position, and cage subsidence were evaluated. Correlation between center point ratio and change in lordosis was assessed using the Spearman correlation coefficient. Secondary analysis included multiple linear regression to determine independent predictors of change in SL. Results: A total of 126 patients were included in the final analysis, with 51 patients receiving a 5-degree cage and 75 patients receiving a 12-degree cage. There were no differences in the postoperative minus preoperative LL (∆LL) (12-degree cage: −1.66 degrees vs. 5-degree cage: −2.88 degrees, P=0.528) or ∆SL (12-degree cage: −0.79 degrees vs. 5-degree cage: −1.68 degrees, P=0.513) at 1-month follow-up. Furthermore, no differences were found in ∆LL (12-degree cage: 2.40 degrees vs. 5-degree cage: 1.00 degrees, P=0.497) or ∆SL (12-degree cage: 1.24 degrees vs. 5-degree cage: 0.35 degrees, P=0.541) at final follow-up. Regression analysis failed to show demographic factors, cage positioning, or cage lordosis to be independent predictors of change in SL. No difference in subsidence was found between groups (12-degree cage: 25.5% vs. 5-degree cage: 32%, P=0.431). Conclusion: Lordotic cage angle and cage positioning were not associated with perioperative changes in LL, SL, or cage subsidence after single-level TLIF. Level of Evidence: Level III.

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

Cited by 23 publications

References 28 publications

Full Endoscopic Lumbar Transforaminal Interbody Fusion in DDD Lumbar Degenerative Disc Disease: A Latest Technique

Full Endoscopic Lumbar Transforaminal Interbody Fusion in DDD Lumbar Degenerative Disc Disease: A Latest Technique

Expandable Interbody Fusion Cages: An Editorial on the Surgeon's Perspective on Recent Technological Advances and Their Biomechanical Implications

Does Interbody Cage Lordosis and Position Affect Radiographic Outcomes After Single-level Transforaminal Lumbar Interbody Fusion?

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