Segmental Lordosis After Open Transforaminal Lumbar Interbody Fusion Using Expandable Oblique Versus Static Anterior Banana Cages.

Abstract

Background and objectives: Expandable oblique interbody cages have gained popularity because of their suitability in minimally invasive surgical approaches and their ease of operative insertion. We aimed to determine whether static anteriorly placed banana cages or expandable obliquely placed cages provide greater lordosis when performing open transforaminal lumbar interbody fusion with concomitant posterior column osteotomy (PCO).

Methods: We performed a single-surgeon retrospective consecutive cohort study which compared patients who underwent transforaminal lumbar interbody fusion using a static anteriorly placed banana cage vs an expandable obliquely placed cage. All TLIFs were performed open with PCO and included patients with focal degenerative pathology as well as global spinal deformity. Patient data were collected preoperatively, at 6-month follow-up, and at the last available follow-up. The primary outcome was defined as the change in segmental lordosis (ΔSL) measured using 6-month postoperative upright lumbar spine x-rays.

Results: In total, 210 patients met inclusion criteria, including a total of 227 static cages and 100 expandable cages. The median ΔSL for the expandable cohort was significantly higher than the static cohort (6.1° [2.4, 8.4] vs 4.1° [1.3, 6.9], P = .016). This difference persisted after multivariate regression analyses and propensity score matching. Preoperative SL was found to have the greatest impact on ΔSL with a 3.23° increase for segments with preoperative SL < 15° compared with segments with preoperative SL ≥ 25° (P < .001). The overall median (T12-S1) delta lumbar lordosis (ΔLL) for all patients was 3.5° [-0.5, 10.2]. Although ΔLL was larger for static cages (median difference of 2.2°, P = .031), after propensity score matching, the expandable cage cohort experienced 3.24° greater ΔLL compared with the static cohort (P = .004).

Conclusion: Open TLIFs performed in conjunction with a PCO yielded 2.0° greater median ΔSL when using expandable obliquely placed cages compared with using static anteriorly placed banana cages. This represents a 50% increase between static and expandable cages. Cage type did not provide a clear advantage for overall ΔLL.