Abstract
INTRODUCTION: Subsidence has been a common concern or complication in patients undergoing TLIF with an expandable cage or standalone DLIF with a static cage. It could lead to further complications such as pseudoarthrosis, lumbar kyphosis, and radiculopathy. Recently, expandable technology has emerged in lateral interbody fusion, which could be delivered through the smaller surgical corridors. Therefore we sought to determine the extent of radiological outcome and subsidence rate in patients with expandable cages. METHODS: A retrospective review of patients who underwent DLIF was performed. Only patients with degenerative lumbar disc disease were included. Baseline demographic and radiographic outcomes such as cage subsidence, anterior and posterior disc height, foraminal dimensions, and other spinopelvic parameters were collected. The primary endpoint was severe cage subsidence (grade 2 and 3) per level according to the classification by Marchi et al. Multivariate Analysis was performed. RESULTS: 59 patients underwent DLIF with expandable (n = 25) and static (n = 34) cages respectively. Both expandable and static groups have comparable baseline demographic such as age, gender, BMI, and medical comorbidities. The average follow-up period was 16 months. Both groups also had a comparable rate of the standalone construct (40% vs 68%, p 0.088). Significant higher cage width and length were used in the expandable group. However, there were no statistically significant differences in the restoration of both anterior and posterior disc heights, foraminal height, and central canal diameter. A significantly lower rate of severe subsidence was observed in the expandable group (4% vs 26.5%, p = 0.023) compared to the static group. CONCLUSIONS: In our study, expandable cages in DLIF patients were observed to have a significantly lower rate of subsidence when compared to those who received static cages.
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