Khanathip Jitpakdee, Chibuikem A Ikwuegbuenyi, Minaam Farooq, Fabian Sommer, Edna Gouveia, Blake I Boadi, Jessica Berger, Ibrahim Hussain, Roger Härtl
{"title":"导航辅助微创经椎间孔腰椎椎体间融合术中2种可扩展Cage设计的1年临床和影像学结果比较","authors":"Khanathip Jitpakdee, Chibuikem A Ikwuegbuenyi, Minaam Farooq, Fabian Sommer, Edna Gouveia, Blake I Boadi, Jessica Berger, Ibrahim Hussain, Roger Härtl","doi":"10.14444/8797","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) often struggles to provide sufficient lordotic alignment restoration. The choice of cage design, including its height and lordotic angle, is critical. This study compares 2 expandable cage designs in MIS-TLIF: one that increases only disc height (group H) and another that expands both height and lordosis (group HL).</p><p><strong>Methods: </strong>Seventy-five patients who underwent navigation-assisted MIS-TLIF using expandable cages were reviewed. These included 35 cases using expandable cages that increase only height (group H) and 40 cases using cages that expand both height and lordosis (group HL). Clinical outcomes, including a numeric rating scale of back pain, leg pain, and Oswestry Disability Index and radiographic parameters, including disc height, lordotic angle, subsidence, and fusion rates, were evaluated.</p><p><strong>Results: </strong>Both groups showed significant improvements in clinical outcomes, with no differences between groups. Postoperative disc and foraminal height increased significantly. At the 1-year follow-up, group HL demonstrated greater improvements in segmental lordosis (4.0° ± 3.3° vs 1.9° ± 5.4°, <i>P</i> = 0.018) and disc angle (5.8° ± 4.1° vs 1.9° ± 4.2°, <i>P</i> < 0.001) compared with group H. The overall fusion rate was 92%, and the overall subsidence rate was 32%, which decreased to 20% after the first 20 cases. No neurological injuries occurred, and there were no significant differences in complications between the groups.</p><p><strong>Conclusion: </strong>This study demonstrates that MIS-TLIF with expandable cages designed to increase lordosis offers superior improvement in segmental lordosis at the 1-year follow-up, compared with expandable cages that only expand disc height. Both cage designs achieved high fusion rates and showed similar clinical outcomes.</p><p><strong>Clinical relevance: </strong>The surgeon's experience in the use of expandable cages is a critical factor in reducing the risk of cage subsidence, a complication that may adversely affect clinical outcomes.</p><p><strong>Level of evidence: 3: </strong></p>","PeriodicalId":38486,"journal":{"name":"International Journal of Spine Surgery","volume":" ","pages":""},"PeriodicalIF":1.7000,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Comparison of 1-Year Clinical and Radiographic Outcomes Between 2 Expandable Cage Designs in Navigation-Assisted Minimally Invasive Transforaminal Lumbar Interbody Fusion.\",\"authors\":\"Khanathip Jitpakdee, Chibuikem A Ikwuegbuenyi, Minaam Farooq, Fabian Sommer, Edna Gouveia, Blake I Boadi, Jessica Berger, Ibrahim Hussain, Roger Härtl\",\"doi\":\"10.14444/8797\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) often struggles to provide sufficient lordotic alignment restoration. The choice of cage design, including its height and lordotic angle, is critical. This study compares 2 expandable cage designs in MIS-TLIF: one that increases only disc height (group H) and another that expands both height and lordosis (group HL).</p><p><strong>Methods: </strong>Seventy-five patients who underwent navigation-assisted MIS-TLIF using expandable cages were reviewed. These included 35 cases using expandable cages that increase only height (group H) and 40 cases using cages that expand both height and lordosis (group HL). Clinical outcomes, including a numeric rating scale of back pain, leg pain, and Oswestry Disability Index and radiographic parameters, including disc height, lordotic angle, subsidence, and fusion rates, were evaluated.</p><p><strong>Results: </strong>Both groups showed significant improvements in clinical outcomes, with no differences between groups. Postoperative disc and foraminal height increased significantly. At the 1-year follow-up, group HL demonstrated greater improvements in segmental lordosis (4.0° ± 3.3° vs 1.9° ± 5.4°, <i>P</i> = 0.018) and disc angle (5.8° ± 4.1° vs 1.9° ± 4.2°, <i>P</i> < 0.001) compared with group H. The overall fusion rate was 92%, and the overall subsidence rate was 32%, which decreased to 20% after the first 20 cases. No neurological injuries occurred, and there were no significant differences in complications between the groups.</p><p><strong>Conclusion: </strong>This study demonstrates that MIS-TLIF with expandable cages designed to increase lordosis offers superior improvement in segmental lordosis at the 1-year follow-up, compared with expandable cages that only expand disc height. Both cage designs achieved high fusion rates and showed similar clinical outcomes.</p><p><strong>Clinical relevance: </strong>The surgeon's experience in the use of expandable cages is a critical factor in reducing the risk of cage subsidence, a complication that may adversely affect clinical outcomes.</p><p><strong>Level of evidence: 3: </strong></p>\",\"PeriodicalId\":38486,\"journal\":{\"name\":\"International Journal of Spine Surgery\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":1.7000,\"publicationDate\":\"2025-09-25\",\"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/10.14444/8797\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"SURGERY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"International Journal of Spine Surgery","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.14444/8797","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"SURGERY","Score":null,"Total":0}
Comparison of 1-Year Clinical and Radiographic Outcomes Between 2 Expandable Cage Designs in Navigation-Assisted Minimally Invasive Transforaminal Lumbar Interbody Fusion.
Background: Minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) often struggles to provide sufficient lordotic alignment restoration. The choice of cage design, including its height and lordotic angle, is critical. This study compares 2 expandable cage designs in MIS-TLIF: one that increases only disc height (group H) and another that expands both height and lordosis (group HL).
Methods: Seventy-five patients who underwent navigation-assisted MIS-TLIF using expandable cages were reviewed. These included 35 cases using expandable cages that increase only height (group H) and 40 cases using cages that expand both height and lordosis (group HL). Clinical outcomes, including a numeric rating scale of back pain, leg pain, and Oswestry Disability Index and radiographic parameters, including disc height, lordotic angle, subsidence, and fusion rates, were evaluated.
Results: Both groups showed significant improvements in clinical outcomes, with no differences between groups. Postoperative disc and foraminal height increased significantly. At the 1-year follow-up, group HL demonstrated greater improvements in segmental lordosis (4.0° ± 3.3° vs 1.9° ± 5.4°, P = 0.018) and disc angle (5.8° ± 4.1° vs 1.9° ± 4.2°, P < 0.001) compared with group H. The overall fusion rate was 92%, and the overall subsidence rate was 32%, which decreased to 20% after the first 20 cases. No neurological injuries occurred, and there were no significant differences in complications between the groups.
Conclusion: This study demonstrates that MIS-TLIF with expandable cages designed to increase lordosis offers superior improvement in segmental lordosis at the 1-year follow-up, compared with expandable cages that only expand disc height. Both cage designs achieved high fusion rates and showed similar clinical outcomes.
Clinical relevance: The surgeon's experience in the use of expandable cages is a critical factor in reducing the risk of cage subsidence, a complication that may adversely affect clinical outcomes.
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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