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Paper title Clinical and Radiological Outcomes in Minimally Invasive Transforaminal Lumbar Interbody Fusion with Expandable Cages
Paper code P51
  1. Astrid Jilch Ente Ospedaliero Cantonale Speaker
  2. Dario Giunchi Ospedale Regionale di Lugano
  3. Pietro Scarone Ospedale Regionale di Lugano - Neurocentro della Svizzera Italiana
Form of presentation Poster
  • SSNR-Neuroradiology
Abstract text Aims: Minimally invasive transforaminal lumbar interbody fusion (MIS TLIF) with oblique cage is widely used for treatment of degenerative disc disease, foraminal stenosis and spondylolisthesis. Main problems related to this approach are secondary mobilisation of interbody cages and quality of interbody fusion. Use of expandable technology could allow to solve these problems, but data from literature concerning expandable cages are scarce.
The aim of this study was to retrospectively analyze clinical and radiographic outcomes in a consecutive series of patients who have undergone MIS TLIF with an expandable titanium cage with minimum 1 year follow-up.

Methods: Patient population and study design: We retrospectively analyzed a series of 17 patients (18 to 80 years), operated between 2015 and 2016.. Demographic and clinical data, clinical outcome scores, device-related complications as well as radiographic and anatomic features (disc height, foraminal height, grade of foraminal stenosis, fusion) were recorded. We did not use expandable cages in patients with scoliosis, spinal tumors, and osteoporosis.

Results: The leading symptoms (64.70%) were the combination of lumbago and radiculopathy. The underlying pathologic conditions were mostly foraminal stenosis and degenerative or isthmic lytic spondilolisthesis (41.17%). Mean hospital stay was 7.76 days ±3.01. Three medical complications were recorded perioperatively, not related to surgical approach.. Long-term complications during follow-up included persistent neuropathic pain in the lower limbs in 1 patient.. No patient needed reoperation and no patient showed mobilization of the cage during follow-up. Mean follow-up was 12.4 months. Mean back and leg pain intensity before surgery was graded 8.8 points (±1.03) and 5.1 points (±2.85) on the VAS, and improved postoperatively to 3.5 points (±2.99) and 2.1 points (±2.69) respectively. The mean ODI was 55.99% (±15.77) preoperatively and 10.21% (±11.68) postoperatively. The majorityof tpatients (11; 64.70%) showed complete fusion and 6 patients (35.29%) a partial fusion. Subsidence of the cageoccurred in 4 patients (23.52%).

Conclusions: MS TLIF surgery with an titanium expandable lumbar fusion device led to favorable clinical and radiographic outcome with durable restoration of the disk and foraminal height without major neurological or device-related complications. Use of expandable cages did not improve fusion rate in this series. Incidence of cage subsidence was significant, and comparable to recently reported data from other series. However, this was not associated with worse clinical outcome.
We plan to perform a prospective randomized study on clinical and radiographic parameters in patients undergoing MIS TLIF surgery with expandable versus static cages as well as on the cost-effectiveness.