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Early Experience With Uniplanar Versus Biplanar Expandable Interbody Fusion Devices in Single-Level Minimally
Jonathan A Ledesma1, Jesse C Ottaway1, Mark J Lambrechts1
1Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA, USA.
Neurospine
|July 4, 2023
Summary
Both uniplanar and biplanar expandable cages effectively improve spinal fusion outcomes. This study found no significant differences in radiographic results, subsidence, or patient-reported outcomes between the two cage types in minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF).
Area of Science:
- Spine surgery
- Orthopedic surgery
- Biomaterials in spinal fusion
Background:
- Minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) is a common procedure for lumbar spine instability.
- Expandable interbody cages aim to restore disc height and lordosis, facilitating fusion.
- Uniplanar and biplanar cage designs differ in their ability to accommodate segmental motion and lordotic adjustments.
Purpose of the Study:
- To compare early radiographic and clinical outcomes of expandable uniplanar versus biplanar cages in single-level MIS-TLIF.
- To evaluate differences in disc height restoration, segmental lordosis, and patient-reported outcomes.
- To assess subsidence rates, complication rates, and fusion success between cage types.
Main Methods:
- Retrospective review of 93 patients undergoing single-level MIS-TLIF with either uniplanar or biplanar polyetheretherketone cages.
- Radiographic measurements (disc height, lordosis) taken preoperatively, at 6 weeks, and 1 year postoperatively.
- Clinical outcomes assessed using Oswestry Disability Index (ODI) and visual analogue scale (VAS) for back and leg pain at 3 months and 1 year.
Main Results:
- Both cage types significantly improved disc height and segmental lordosis at 1 year.
- No significant differences in subsidence rates at 6 weeks or 1 year between uniplanar (21.9%) and biplanar (32.7%) cages.
- Similar improvements in ODI and VAS scores, and achievement of minimal clinically important difference, were observed in both groups.
- No significant differences in complication rates, readmission rates, revision surgeries, or 1-year fusion rates were found.
Conclusions:
- Expandable uniplanar and biplanar cages are safe and effective for MIS-TLIF, improving radiographic and patient-reported outcomes.
- No significant differences were observed in radiographic outcomes, subsidence, patient-reported measures, or complications between uniplanar and biplanar expandable cages.
- Both cage designs provide comparable results for single-level lumbar interbody fusion.
