Minimally Invasive Transforaminal Lumbar Interbody Fusion with Expandable Cages

Area of Science:

• Spine surgery
• Orthopedic surgery
• Minimally invasive procedures

Background:

• Minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) is increasingly used for lumbar degenerative pathologies.
• MIS-TLIF offers reduced soft-tissue injury, less pain, and faster recovery compared to open techniques.
• The narrow surgical access in MIS-TLIF complicates interbody cage placement.

Purpose of the Study:

• To describe the technique and potential benefits of using expandable cages in MIS-TLIF.
• To highlight the advantages of expandable cages in addressing the challenges of MIS-TLIF.

Main Methods:

• The procedure involves general anesthesia, prone positioning, and Wiltse intermuscular approaches.
• Key steps include pedicle screw placement, facetectomies, discectomy, end-plate preparation, and cage implantation.
• Expandable cages are inserted in a collapsed state and expanded in situ, followed by graft material placement and rod fixation.

Main Results:

• Expandable cages are designed for easier insertion with less impaction, minimizing end-plate damage.
• They require reduced thecal and nerve-root retraction.
• Expanded cages offer a larger surface footprint, potentially improving disc height and lordosis restoration.

Conclusions:

• Expandable cages may overcome insertion difficulties associated with MIS-TLIF.
• Their design potentially reduces neurological injury and improves spinal reconstruction.
• Further studies are needed to compare expandable cages with traditional static cages in TLIF surgery.