Minimally Invasive Transforaminal Lumbar Interbody Fusion Using Expandable Technology: A Clinical and Radiographic Analysis of 50 Patients.
OBJECTIVE Interbody cage implantation during minimally invasive surgery for transforaminal lumbar interbody fusion (MIS TLIF) presents challenges. Expandable cages when collapsed facilitate insertion; subsequent expansion in situ optimizes endplate contact. This report describes clinical and radiographic outcomes of MIS TLIF with an expandable cage. METHODS Researchers retrospectively analyzed prospective data from 50 patients (62 operative levels) when an expandable interbody spacer was combined with transpedicular posterior stabilization. Clinical outcomes, fusion rates, incidence of reoperation, and device related complications were obtained from clinical and radiographic records. RESULTS Mean patient age was 58.1 years (56.2% female) In all, 76% (38/50) underwent 1 level fusion, and 24% (12/50) 2 level fusion. Average operative time was 239.9 86.9 minutes for 1 level and 350.3 74.9 minutes for 2 level procedures; average hospital stay overall was 2.5 1.7 days, with no intraoperative complications reported. Mean visual analogue scale and Oswestry Disability Index scores decreased significantly from preoperative to all postoperative assessment times (6, 12, and 24 months) (P 0.05) Intervertebral disc height (8.3 2.7 vs. 11.3 1.9 mm) increased significantly, with increases sustained over 24 months (P 0.05) Postoperative radiographs showed no evidence of cage migration, subsidence, or collapse and suggested fusion at all operative levels by 12 months and 24 months (93% 54/58; 97% 28/29) respectively. CONCLUSIONS An expandable interbody cage led to significant improvement in clinical and radiographic outcomes after MIS TLIF, including intervertebral disc height restoration and high fusion rates, with no evidence of device related complications.
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