脊椎ジャーナル

Transforaminal Lumbar Interbody Fusion with Expandable Interbody Device Provides Indirect Decompression through Significant Disc Height Restoration

Abstract

Jonathon B Gentry, Son Le, Jessica R Riggleman, Samantha L Greeley, Leigh Ahrendtsen and Charles Ledonio

Background: Achieving and maintaining indirect decompression is critical to the success of open transforaminal lumbar interbody fusion (O-TLIF) because it directly correlates with improved patient outcomes. This has led to significant advancements in interbody design. Expandable interbody devices have been developed to optimize the restoration of disc height, neuroforaminal height, and lordosis while minimizing endplate disruption.

Objective: The objective of this study is to quantify the radiographic outcomes of patients who underwent O-TLIF using an expandable interbody spacer.

Methods: Single-surgeon, retrospective, Institutional Review Board-exempt chart review of 68 consecutive patients who underwent O-TLIF at 1–2 contiguous level(s) using expandable interbody spacers. Radiographic outcomes were collected and compared at preoperative and postoperative timepoints up to 12 months. Statistical results were significant if P<0.05.

Results: Over a three-year period, 68 consecutive patients underwent O-TLIF with a titanium expandable interbody spacer. The patients were 48.5% (33/68) female and 51.5% (35/68) male, with an average age of 52.6 ± 12.7 years. Mean anterior and posterior disc heights significantly improved by 3.8 ± 2.6 mm and 3.0 ± 2.5 mm, respectively, at 12 months (all P<0.001). Mean neuroforaminal height significantly improved by 2.9 ± 3.9 mm at 12 months (P<0.001). Mean intervertebral angle significantly improved by 1.4 ± 4.0° at 12 months (P=0.002). Mean pelvic incidence minus lumbar lordosis mismatch significantly decreased by 2.3 ± 8.4° at 12 months (P=0.035).

Conclusion: Anterior and posterior disc height, neuroforaminal height, and intervertebral angles were restored, providing evidence of indirect decompression. Segmental and lumbar lordosis was sustained. Expandable technology proved to be effective in the studied patients when used in an O-TLIF technique.