{"title":"Segmental Lordosis and Disc Height Discrepancies in Lateral Lumbar Interbody Fusion Using Expandable Cages.","authors":"Akihiko Hiyama, Daisuke Sakai, Hiroyuki Katoh, Masato Sato, Masahiko Watanabe","doi":"10.14444/8726","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>This study evaluated discrepancies between the expected intervertebral disc height (DH) and segmental lordosis (SL), defined as predicted values based on the rotations of the expandable cage driver, and the actual DH and SL achieved postoperatively in lateral lumbar interbody fusion (LLIF) using expandable cages.</p><p><strong>Methods: </strong>A retrospective review was conducted on patients who underwent LLIF with expandable cages between May 2022 and May 2024. The study included 51 patients (28 men and 23 women; mean age: 70.6 ± 11.7 years). Surgical outcomes measured included SL, anterior DH, posterior DH, average DH, canal diameter, and central canal area (CCA). Pre- and postoperative measurements were compared to evaluate cage effectiveness.</p><p><strong>Results: </strong>Postoperative measurements showed significant improvements: SL increased from 3.5° to 4.8° (<i>P</i> = 0.002), anterior DH from 5.9 to 10.7 mm (<i>P</i> < 0.001), PDH from 3.4 to 7.7 mm (<i>P</i> < 0.001), and average DH from 4.6 to 9.2 mm (<i>P</i> < 0.001). Despite these gains, the actual SL (4.8°) was significantly lower than the predicted SL (8.7°, <i>P</i> < 0.001). Canal dimensions also improved, with canal diameter increasing from 5.0 to 8.3 mm and CCA from 55.8 to 89.7 mm² (<i>P</i> < 0.001 for both). A significant correlation was found between changes in posterior DH and CCA (<i>r</i> = 0.272, <i>P</i> = 0.017).</p><p><strong>Conclusion: </strong>Expandable cages in LLIF significantly improved DH, SL, and canal dimensions, contributing to better clinical outcomes. However, achieving the ideal SL remains challenging, highlighting the need for further refinement in surgical techniques and cage design.</p><p><strong>Clinical relevance: </strong>Expandable cages in LLIF significantly enhance DH, SL, and spinal canal dimensions, which contribute to improved clinical outcomes such as pain relief and functional recovery. However, the difficulty in achieving the ideal SL suggests further advancements are needed in surgical techniques and cage design to optimize patient outcomes and long-term spinal alignment.</p><p><strong>Level of evidence: 3: </strong></p>","PeriodicalId":38486,"journal":{"name":"International Journal of Spine Surgery","volume":" ","pages":""},"PeriodicalIF":1.7000,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"International Journal of Spine Surgery","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.14444/8726","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"SURGERY","Score":null,"Total":0}
引用次数: 0
Abstract
Background: This study evaluated discrepancies between the expected intervertebral disc height (DH) and segmental lordosis (SL), defined as predicted values based on the rotations of the expandable cage driver, and the actual DH and SL achieved postoperatively in lateral lumbar interbody fusion (LLIF) using expandable cages.
Methods: A retrospective review was conducted on patients who underwent LLIF with expandable cages between May 2022 and May 2024. The study included 51 patients (28 men and 23 women; mean age: 70.6 ± 11.7 years). Surgical outcomes measured included SL, anterior DH, posterior DH, average DH, canal diameter, and central canal area (CCA). Pre- and postoperative measurements were compared to evaluate cage effectiveness.
Results: Postoperative measurements showed significant improvements: SL increased from 3.5° to 4.8° (P = 0.002), anterior DH from 5.9 to 10.7 mm (P < 0.001), PDH from 3.4 to 7.7 mm (P < 0.001), and average DH from 4.6 to 9.2 mm (P < 0.001). Despite these gains, the actual SL (4.8°) was significantly lower than the predicted SL (8.7°, P < 0.001). Canal dimensions also improved, with canal diameter increasing from 5.0 to 8.3 mm and CCA from 55.8 to 89.7 mm² (P < 0.001 for both). A significant correlation was found between changes in posterior DH and CCA (r = 0.272, P = 0.017).
Conclusion: Expandable cages in LLIF significantly improved DH, SL, and canal dimensions, contributing to better clinical outcomes. However, achieving the ideal SL remains challenging, highlighting the need for further refinement in surgical techniques and cage design.
Clinical relevance: Expandable cages in LLIF significantly enhance DH, SL, and spinal canal dimensions, which contribute to improved clinical outcomes such as pain relief and functional recovery. However, the difficulty in achieving the ideal SL suggests further advancements are needed in surgical techniques and cage design to optimize patient outcomes and long-term spinal alignment.
期刊介绍：
The International Journal of Spine Surgery is the official scientific journal of ISASS, the International Intradiscal Therapy Society, the Pittsburgh Spine Summit, and the Büttner-Janz Spinefoundation, and is an official partner of the Southern Neurosurgical Society. The goal of the International Journal of Spine Surgery is to promote and disseminate online the most up-to-date scientific and clinical research into innovations in motion preservation and new spinal surgery technology, including basic science, biologics, and tissue engineering. The Journal is dedicated to educating spine surgeons worldwide by reporting on the scientific basis, indications, surgical techniques, complications, outcomes, and follow-up data for promising spinal procedures.
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