Biplanar Expandable Cages for Transforaminal Lumbar Interbody Fusion Are Safe and Achieve Good 1-Year Clinical and Radiological Outcomes in an Asian Population.

Abstract

This study investigated 1-year clinical and radiological outcomes of biplanar expandable (BE) cages following transforaminal lumbar interbody fusion (TLIF) in an Asian population. A retrospective review was conducted of all consecutive patients who underwent TLIF with BE cages performed by 2 fellowship-trained spine surgeons from 2020 to 2021. Inclusion criteria included open or minimally invasive (MIS) TLIF, of up to 3 spinal segments, performed for treatment of degenerative disc disease, spondylolisthesis, or spinal stenosis. Patient-reported outcomes, including visual analog score (VAS) for back and lower limb pain, Oswestry Disability Index (ODI) and North American Spine Society neurogenic symptom score (NSS), and various radiographic parameters, were evaluated. A total of 23 patients underwent TLIF with BE cages with a follow-up duration of 1.25 years. Of those patients, 7 (30%) underwent 1-level TLIF, 12 (52%) underwent 2-level TLIF, and 4 (18%) underwent 3-level TLIF, with a total of 43 spinal segments fused. Four patients (17%) underwent MIS TLIF while 19 patients (83%) underwent open TLIF. VAS for back pain scores improved by 4.8 ± 3.4 (P < 0.001) from 6.5 ± 2.6 to 1.7 ± 2.2; VAS for lower limb pain scores improved by 5.2 ± 3.8 (P < 0.001) from 5.7 ± 3.4 to 0.5 ± 1.6; ODI scores improved by 29.0 ± 18.1 (P < 0.001) from 49.4 ± 15.1 to 20.4 ± 14.2; and NSS scores improved by 36.8 ± 22.1 (P < 0.001) from 53.3 ± 21.1 to 16.5 ± 19.8. Significant improvements in radiological parameters included increase in anterior disc height, posterior disc height, foraminal height, segmental lordosis, and lumbar lordosis. There were no implant-related complications, cage subsidence, cage migration, or revision surgery at 1 year. TLIF performed with BE cages led to significantly improved patient-reported outcomes and radiographic parameters at 1 year and is safe for use in Asians. The results of this study support the effectiveness and safety of TLIF with biplanar expandable cages.