Search Results (198)

Background: Transforaminal lumbar interbody fusion (TLIF) with static cages is a frequently performed procedure. Larger series focusing on the use of expandable TLIF spacers are less common. Methods: This retrospective, single-center observational cohort study reviewed consecutive patients treated by TLIF using expandable titanium interbody implants (ALTERA™, Globus Medical Inc., Audubon, PA, USA) for degenerative pathologies from L2-S1 between 11/2018 and 09/2023. Surgical parameters, adverse events, radiological outcomes (fusion rate, segmental lordosis, spinopelvic parameters), and clinical outcomes were analyzed through a mean postoperative follow-up of 12 months. Results: This study identified 270 patients (mean age 65 years, 50.4% female) who underwent TLIF with expandable interbody spacers at 324 levels. Clinical outcomes were good or excellent in 74.1% of patients at 3 months and 71.8% at 12 months. Radiographic fusion was achieved in 73.1% of assessable segments at 12 months. Segmental lordosis increased significantly from 17.8° preoperatively to 20.0° at 12 months (p < 0.001). Adverse event (AE) rates were acceptable across all timepoints, with no device failures or device-associated complications observed. Conclusions: This study demonstrates that TLIF with expandable titanium interbody implants was safe, associated with high fusion rates, and enabled significant restoration of segmental lordosis that was maintained during follow-up. Full article

The management of adult spinal deformity (ASD) has evolved dramatically over the past century, transitioning from external bracing and in situ fusion to complex, technology-driven surgical interventions. This review traces the historical development of spinal deformity correction and highlights contemporary enabling technologies that are redefining the surgical landscape. Advances in stereoradiographic imaging now allow for precise, low-dose three-dimensional assessment of spinopelvic parameters and segmental bone density, facilitating individualized surgical planning. Robotic assistance and intraoperative navigation improve the accuracy and safety of instrumentation, while patient-specific rods and interbody implants enhance biomechanical conformity and alignment precision. Machine learning and predictive modeling tools have emerged as valuable adjuncts for risk stratification, surgical planning, and outcome forecasting. Minimally invasive deformity correction strategies, including anterior column realignment and circumferential minimally invasive surgery (cMIS), have demonstrated equivalent clinical and radiographic outcomes to traditional open surgery with reduced perioperative morbidity in select patients. Despite these advancements, complications such as proximal junctional kyphosis and failure remain prevalent. Adjunctive strategies—including ligamentous tethering, modified proximal fixation, and vertebral cement augmentation—offer promising preventive potential. Collectively, these innovations signal a paradigm shift toward precision spine surgery, characterized by data-informed decision-making, individualized construct design, and improved patient-centered outcomes in spinal deformity care. Full article

Objective: This study aimed to compare the clinical and radiological outcomes of dynamic rod stabilization with and without transforaminal lumbar interbody fusion (TLIF) in patients undergoing surgery for degenerative lumbar instability. Specifically, we evaluated the prognostic value of hybrid systems in reducing adjacent segment disease (ASD), enhancing fusion rates, and improving functional outcomes. Methods: A retrospective analysis was conducted on 62 patients treated between 2019 and 2022. Group 1 (n = 34) underwent dynamic rod stabilization alone, while Group 2 (n = 28) received dynamic stabilization combined with TLIF. Radiological assessments included disk height index (DHI) and fusion rates. Clinical outcomes were measured using the Visual Analog Scale (VAS) for back and leg pain at baseline, 12, and 24 months. Statistical analysis was performed using Jamovi^® software (version 2.4.1). Results: The hybrid group (dynamic + TLIF) demonstrated significantly higher anterior fusion rates (p < 0.001) and greater improvement in VAS scores for back (p = 0.005) and leg pain (p < 0.001) at 12 months. Although operative time was longer (p = 0.002), there was no significant difference in hospital stay (p = 0.635). No significant differences were observed in ASD development (p = 0.11) or pseudoarthrosis (p = 0.396). The hybrid group maintained better lumbar lordosis and higher adjacent segment DHI. Conclusions: Hybrid dynamic stabilization combined with TLIF provides superior clinical outcomes and fusion rates compared to dynamic stabilization alone, without significantly increasing the risk of ASD. These findings support the use of hybrid constructs as a balanced strategy for treating degenerative lumbar instability. Full article

Background: Lumbar Interbody Fusion (LIF) is a surgical procedure aimed at addressing a range of pathological conditions affecting the structure and function of the spine. Patient-Specific Interbody Cages (PSICs) are an emerging technology that are used in LIF; however, there is a lack of clinical outcome data, making it difficult to assess the potential risks, benefits, and value of PSICs. The purpose of this present study is to contribute data to the field on this new emerging technology. The aims were to investigate Quality of Life (QoL), pain, and the complications of PSICs in LIF. To provide a comparative cohort, we performed a systematic review of patient-reported outcomes of conventional fusion techniques. Methods: This study reports on a multi-surgeon, multi-centre clinical trial of patients with lumbar degenerative disc disease, necessitating discectomy and fusion. All patients underwent LIF procedures with 3D-printed PSICs. Pain Visual Analogue Scale (VAS) and QoL (EQ-5D) scores were collected pre-operatively and at 6m, 12m, and 24m post-operatively. For comparative purposes, we performed a systematic review of the VAS scores from traditional LIF cages and analysed the Australian Spine Registry QoL data. Results: The literature search yielded 4272 publications. The studies were subdivided into four groups based on the interbody device type. All the groups demonstrated improvements in the VAS (for back pain) scores post-operatively. In total, 78 patients (109 instrumented levels) underwent LIF procedures with 3DP PSICs. There were three reoperations (3.8%) and no revisions of any PSIC. The mean VAS scores improved significantly (p < 0.01) from 7.85 (1.50 SD) pre-operatively to 2.03 (2.13 SD) at 24 months post-operatively. The mean QoL index scores improved significantly (p < 0.01) from a pre-operative 0.257 (0.332 SD) to 0.815 (0.208 SD) at 24 months. Conclusions: The systematic review indicated that device fixation to the interbody space was associated with lower VAS scores. The results from the investigational cohort suggest that PSICs may represent a new progression in implant design for spinal fusion, with an associated clinical benefit for LIF. Full article

Background: Structured titanium (ST) cages are designed to enhance osseointegration and fusion in lumbar interbody procedures. However, clinical and radiological outcomes following TLIF using ST cages—particularly with or without adjacent-level dynamic stabilization (DSS)—have not been widely reported. Objective: To evaluate 12-month fusion outcomes and patient-reported outcomes (PROMs) after TLIF with structured titanium cages, comparing cases with and without adjacent-level DSS. Methods: In this retrospective cohort study, 82 patients undergoing TLIF with ST cages were analyzed—41 with hybrid instrumentation (TLIF + DSS) and 41 with TLIF alone. PROMs (ODI, VAS for back and leg pain, EQ-5D-5L) were assessed preoperatively and at 12 months. Fusion was assessed via CT scans at 12 months. Results: PROMs significantly improved over time in both groups (p < 0.001 for ODI, VAS back, VAS leg), but there were no significant differences between the hybrid and non-hybrid groups. Overall, the interbody fusion rate was 84%. Complete fusion was observed in 84% of the hybrid group and 80% of the TLIF-only group (p = 0.716), with very low rates of non-union. Conclusions: Structured titanium cages demonstrated excellent 1-year fusion rates and supported significant clinical improvement after TLIF. The addition of dynamic stabilization had no measurable effect on patient-reported or radiological outcomes at 12 months. Long-term studies are needed to assess any potential effect of DSS on adjacent segment disease. Full article

Background: Lateral lumbar or thoracic interbody fusion (LLIF) is increasingly considered for anterior column reconstruction and restoring segmental lordosis in degenerative, infectious, or deformity conditions. Reports about using LLIF with expandable interbody spacers for spine trauma are scarce. Methods: In this retrospective, single-center observational cohort study, we reviewed all patients treated by an expandable LLIF interbody spacer (ELSA^® Expandable Integrated LLIF Spacer, Globus Medical Inc) for trauma indication at our spine center between September 2018 and January 2024. The primary outcome measures were fusion rate at 12 months, change in segmental sagittal Cobb angle, and clinical outcome according to the MacNab criteria. Secondary outcomes included adverse events and complications. Results: We identified n = 21 patients with a mean age of 48.3 (standard deviation (SD) 15.7), 47.6% were female. LLIF was mostly performed at T11/12 (n = 4; 19.1%) and T12/L1 (n = 10; 47.5%). Indications were AO Spine type A2 (n = 4, 19.1%), A3 (n = 14; 66.7%) or A4 fractures (n = 3; 14.3%) with ligamentous (B2-type) in eight (38.1%) and hyperextension (B3-type) injury in one patient (4.8%). Surgery included the release of the anterior longitudinal ligament in four cases (19.1%). Intraoperative AEs were noted in n = 1 (4.8%), postoperative AEs in n = 3 (14.3%) at discharge, n = 4 (19.1%) at three, and n = 2 (9.5%) at twelve months. Segmental sagittal Cobb angle changed from 1.3° (preoperative) to 13.3° at twelve months (p < 0.001). Functional outcome was excellent/good in n = 15 (71.4%; four missing) at 12 months. The fusion rate at the LLIF level was 100% at the 12-month follow-up. Conclusions: LLIF with expandable interbody spacers for spine trauma (off-label use) is safe, promotes solid fusion (100% fusion rate at 12 months), and enables correction of sagittal segmental Cobb angle (mean improvement of 12°), with good or excellent clinical outcomes in most patients (71.4%). Full article

Background/Objectives: Lateral lumbar interbody fusion (LLIF) has gained popularity as an effective technique for indirect decompression through ligamentotaxis. Despite the perceived importance of using appropriately sized cages for achieving optimal decompression, comprehensive reports on cage size and its impact on indirect decompression are limited. This study aimed to assess the ligamentotaxis effect by measuring the “backward bulging” length in pre- and postoperative MRIs and examining its correlation with cage size and subsidence. Methods: T2 images of 270 patients with lumbar herniated disc and/or lumbar spondylolisthesis (June 2022 to March 2025) were analyzed for 530 intervertebral spaces. Data on gender, age, length of hospital stay, preoperative and postoperative lumbar JOA scores, and the level of the disease were collected. Measurements included backward bulging length, intervertebral height, and cage subsidence. Statistical analysis was performed using StatMate. Surgical procedures involved oblique lateral interbody fusion (OLIF) to minimize impact on the iliopsoas and lumbar plexus. Trial cages starting from 8 mm were sequentially inserted, with confirmation through lateral fluoroscopy. Posterior fixation was performed using percutaneous pedicle screws. Results: Analysis of 530 intervertebral spaces revealed that 70% could accommodate a cage 3 mm or larger than the preoperative intervertebral height. Significant backward bulging shortening (3 mm or more) occurred in 339 spaces, predominantly with larger cages. Only 8.8% of cases (14/159) with a large backward bulging shortening had an intervertebral height extension of 3 mm or less. On the other hand, a large reduction in backward bulging was observed in 91.3% of cases (339/371) with an intervertebral height extension of 3 mm or more. Postoperative cage subsidence was observed in 9.2% (49/530) of all intervertebral spaces and 8.6% (32/371) in spaces where a cage larger than 3 mm was used. There was no statistically significant difference between these two groups. Conclusions: To achieve a sufficient ligamentotaxis effect, it is necessary to select a cage size that allows for an intervertebral height increase of at least 3 mm compared to the preoperative measurement. Full article

Background/Objectives: While anterior lumbar interbody fusion (ALIF) is a well-established treatment for degenerative lumbar spine pathology, the timing and pace of postoperative recovery remain poorly defined. Understanding these temporal trends is clinically important for setting patient expectations and optimizing postoperative care. Methods: This retrospective single-institution study evaluated functional recovery in patients undergoing primary, single-level stand-alone (SA) ALIF, or with percutaneous posterior instrumentation (PI). Patient-reported outcome measures (PROMs), including the Oswestry Disability Index (ODI), the Visual Analog Scale (VAS) for back and leg pain, and the SF-12 Physical Component Score (PCS), were assessed preoperatively and at 2 weeks, 6 weeks, 3 months, 6 months, 1 year, and 2 years postoperatively. Achievement of minimum clinically important difference (MCID), global rating change (GRC), and return-to-activity milestones were also analyzed. Results: A total of 143 patients were included (90 SA; 53 PI). PROMs showed significant improvement through 1 year. VAS-back improved by 2 weeks, while ODI and SF12 PCS initially worsened but improved after 6 weeks. By 6 months, over half of the cohort achieved MCID, with continued gains through 1 year. Most patients returned to driving and work, and over 90% discontinued narcotics. Recovery trajectories were comparable between groups, despite early delays in the instrumented cohort. Conclusions: These findings provide time-specific recovery benchmarks that can guide surgical decision-making, patient education, and expectations around functional milestones. Full article

The traditional bilateral pedicle screw system has been used for the treatment of various lumbar spine conditions including advanced degenerative disc disease. However, there is an ongoing need to develop more effective and less invasive techniques. The purpose of this study was to compare the traditional bilateral pedicle screw system (BPSS) with the novel reverse transdiscal screw system (RTSS) for lumbar disc degenerative disease. A 3D solid lumbar L1–L5 spine model was developed and validated based on a human CT scan. Fusions were simulated at L3–L4. The first scenario comprised a transforaminal lumbar interbody cage in combination with the bilateral pedicle screw-rod system (BPSS-TLIF). In the second scenario, the same TLIF cage was combined with reverse L3–L4 transdiscal screws (RTSS-TLIF). Testing parameters included range of motion (ROM) in three orthogonal axes, hardware (cage and screw) stress, and shear load resistance. The ROM of the surgical model was reduced by approximately 90% compared to the intact model at the fused level. The RTSS model demonstrated less ROM compared to the BPSS model at the fused level for all loading conditions. Overall, the RTSS model exhibited lower stress on both screws and cage compared with the BPSS model in all biomechanical testing conditions. The RTSS model also exhibited higher anterior and posterior shear load resistance than the BPSS model. In conclusion, the RTSS model proved superior to the BPSS model in all respects. These findings indicate that the RTSS could serve as a feasible option for patients undergoing lumbar fusion, especially for adjacent segment disease, potentially enhancing surgical outcomes for disc degeneration. Full article

Background/Objectives: Stand-alone lateral lumbar interbody fusion (LLIF) remains a debated approach in spinal surgery, with limited published evidence supporting its efficacy without supplemental fixation. This prospective study presents the institutional case series on single-level L3-L4 stand-alone LLIF, using next-generation 3D-printed titanium cages, as treatment for degenerative disc disease (DDD). Methods: A cohort of 49 patients with symptomatic DDD, unresponsive to conservative therapy, underwent stand-alone LLIF at L3-L4 (neither posterior pedicle screws nor lateral plating). Clinical outcomes (VAS and ODI) and radiological parameters (disc height, segmental/lumbar lordosis) were collected preoperatively and at 1, 6, and 12 months. Repeated-measures ANOVA with Bonferroni correction was adopted for statistical analysis. Results: Significant improvements were observed in pain and disability scores at all time points, with the mean VAS score decreasing from 6.53 to 0.29, and ODI from 27.6% to 3.84% at one year (p < 0.001). Radiographic analysis confirmed durable increases in disc height and segmental lordosis. Solid fusion was achieved in 97.9% of cases. No patient required posterior revision; transient neurological symptoms were mild and self-limiting. Conclusions: This study demonstrates that stand-alone LLIF at L3-L4 is safe and effective in achieving stable fusion and clinical–radiological improvement. These results challenge the necessity of supplemental fixation and support the broader adoption of a less invasive fusion paradigm. Full article

Transforaminal lumbar interbody fusion (TLIF) is a commonly employed surgical technique for managing lumbar degenerative disease and spinal instability. While it offers advantages over posterior lumbar interbody fusion (PLIF), traditional TLIF often involves prolonged recovery and morbidity due to muscle retraction. To improve outcomes, several alternative techniques have emerged, including minimally invasive TLIF (MIS-TLIF), trans-Kambin percutaneous TLIF (PE-TLIF), and transfacet TLIF (TF-TLIF). Each approach presents distinct anatomical and technical advantages, yet no standardized framework exists to guide their selection based on individual patient anatomy. In this study, we review the evolution of TLIF techniques and propose a novel algorithm that integrates patient-specific imaging, anatomical variability, and segmentation data to guide surgical decision-making. By analyzing the surgical corridors, indications, and limitations of each approach, and presenting representative clinical cases, we demonstrate how this algorithm can be applied in practice. For instance, TF-TLIF may be optimal in patients requiring direct decompression without major deformity, while PE-TLIF may be appropriate for those with Kambin’s triangles measuring ≥ 9 mm, allowing for indirect decompression. This tailored framework aims to optimize outcomes and reduce complications. Further prospective validation and incorporation of AI-driven segmentation tools are needed to support broader clinical implementation. Full article

This study proposes a novel expandable spinal cage to maximize the effectiveness of spinal fusion surgery in the treatment of lumbar disk disorders and aims to verify its mechanical stability through finite element method (FEM) analysis and mechanical testing. To address the limitations of existing cages, which do not provide sufficient height and angle expansion and have constraints in independently adjusting height and angle with continuous fine-tuning, this study introduces a new linkage mechanism. This design enables precise spinal alignment restoration tailored to the individual anatomical characteristics of patients, even in minimally invasive surgical environments, distinguishing itself from traditional rack-and-pinion or wedge-based designs. The results of FEM analysis and static load testing demonstrated a high correlation between the predicted yield locations in FEM analysis and actual test results. Furthermore, the compression and compression–shear load tests confirmed that the proposed cage achieved an ultimate load exceeding the lowest fifth percentile of FDA-approved products, meeting clinical requirements. The proposed expandable spinal cage offers significant improvements over existing products and has the potential to evolve into a safer and more effective spinal fusion device through further dynamic fatigue testing and clinical studies to assess long-term durability and practical applicability. Full article

Background/Objectives: Degenerative lumbar spine disease (DLSD) is increasingly managed with minimally invasive surgery (MIS) and evolving anesthesia methods. While general anesthesia (GA) remains standard, spinal anesthesia (SA) may offer faster recovery and fewer side effects. This study compares the clinical and economic outcomes of GA versus SA in transforaminal lumbar interbody fusion (TLIF). Methods: A retrospective review of 18 TLIF patients (2018–2022) was performed, with 9 patients in each cohort. Patients were matched by demographics and procedure type. Data collected included operative time, blood loss, complications, postoperative opioid utilization, and 30-day readmissions. Costs were analyzed in categories: anesthesia, implants, inpatient care, operating room (OR) supplies, OR time, and PACU fees, using Wilcoxon Rank T-tests and Pearson Chi-Squared tests. Results: Clinical outcomes such as blood loss, and operative time were similar between groups. However, SA patients had significantly shorter LOS compared to GA (SA: 12 h vs. GA: 84 h, % difference: −150%, p = 0.04). Additionally, SA patients had lower total direct costs ($27,881.85 vs. $35,669.01; p = 0.027). Significant cost reductions with SA were noted in OR supplies/medications ($7367.93 vs. $10,879.46; p = 0.039) and inpatient costs ($621.65 vs. $3092.66; p = 0.027). Within these categories, reductions were observed for intravenous solutions, sedatives/anesthetics, pressure management, labs, imaging, evaluations, hospital care, and medications. Although costs for implants, anesthesia care, OR time, and PACU fees were lower with SA, these differences did not reach statistical significance. Conclusions: In TLIF for DLSD, SA provides significant economic advantages over GA while yielding comparable clinical outcomes. These results support SA as a cost-effective alternative, warranting further prospective studies to confirm these findings. Full article

Background/Objectives: Lumbar spine surgery has undergone significant technological transformation in recent years, driven by the goals of minimizing invasiveness, improving precision, and enhancing clinical outcomes. Emerging tools—including robotics, augmented reality, computer-assisted navigation, and artificial intelligence—have complemented the evolution of minimally invasive surgical (MIS) approaches, such as endoscopic and lateral interbody fusions. Methods: This systematic review evaluates the literature from February 2020 to February 2025 on technological and procedural innovations in LSS. Eligible studies focused on degenerative lumbar pathologies, advanced surgical technologies, and reported clinical or perioperative outcomes. Randomized controlled trials, comparative studies, meta-analyses, and large case series were included. Results: A total of 32 studies met the inclusion criteria. Robotic-assisted surgery demonstrated high accuracy in pedicle screw placement (~92–94%) and reduced intraoperative blood loss and radiation exposure, although long-term clinical outcomes were comparable to conventional techniques. Intraoperative navigation improved instrumentation precision, while AR enhanced ergonomic workflow and reduced surgeon distraction. AI tools showed promise in surgical planning, guidance, and outcome prediction but lacked definitive evidence of clinical superiority. MIS techniques—including endoscopic discectomy and MIS-TLIF—offered reduced blood loss, shorter hospital stays, and faster recovery, with equivalent pain relief, fusion rates, and complication profiles compared to open procedures. Lateral and oblique approaches (XLIF/OLIF) further optimized alignment and indirect decompression, with favorable perioperative metrics. Conclusions: Recent innovations in lumbar spine surgery have enhanced technical precision and perioperative efficiency without compromising patient outcomes. While short-term benefits are clear, long-term clinical advantages and cost-effectiveness require further investigation. Integration of robotics, navigation, AI, and MIS into spine surgery reflects an ongoing shift toward personalized, data-driven, and less invasive care. Full article

Lumbar interbody fusion (LIF) is a standard treatment for spinal instability, yet postoperative subsidence and adjacent segment degeneration (ASD) remain critical challenges. This study evaluates the biomechanical efficacy of personalized porous fusion cages—featuring Gyroid (G-Cage) and Voronoi (V-Cage) architectures—against classic (C-Cage) and personalized (P-Cage) designs, aiming to enhance stability and mitigate subsidence risks. A finite element model of the L3–L4 segment, derived from CT scans of a healthy male volunteer, was developed to simulate six motion modes (compression, rotation, flexion, extension, and left/right bending). Biomechanical parameters, including range of motion (ROM), cage stress, endplate stress, and displacement, were analyzed. The results demonstrated that the V-Cage exhibited superior performance, reducing ROM by 51% in extension, cage stress by 41.7% in compression, and endplate stress by 63.7% in right bending compared to the C-Cage. The porous designs (G-Cage, V-Cage) exhibited biomimetic stress distribution and minimized micromotion, which was attributed to their trabecular-like architectures. These findings highlight the Voronoi-based porous cage as a biomechanically optimized solution, offering enhanced stability and reduced subsidence risk when compared to classic implants. The study underscores the potential of patient-specific porous designs in advancing LIF outcomes, warranting further clinical validation to translate computational insights into practical applications. Full article