Sagittal Alignment and Clinical Outcomes After Biportal Endoscopic Transforaminal Lumbar Interbody Fusion Using a...

Area of Science:

• Spinal surgery
• Orthopedic technology
• Minimally invasive surgery

Background:

• Biportal endoscopic transforaminal lumbar interbody fusion (BE-TLIF) faces challenges like limited working space and endplate damage.
• Expandable cage technology offers potential solutions to these limitations.

Purpose of the Study:

• To evaluate the efficacy of a single bullet-type expandable cage in BE-TLIF.
• Assess sagittal realignment, fusion rates, and clinical outcomes over a one-year period.

Main Methods:

• Retrospective analysis of 29 patients (38 levels) undergoing BE-TLIF with a single expandable cage.
• Radiological assessment of disc height, segmental lordosis, lumbar lordosis, and cage subsidence.
• Clinical evaluation using VAS, ODI, SF-36, and EQ-5D scores.
• Fusion assessment via CT-based Bridwell classification.

Main Results:

• A 92.1% fusion rate was achieved at 12 months, with minimal significant subsidence.
• Significant improvements in disc height, segmental lordosis, and lumbar lordosis were observed.
• Patients reported reduced pain (VAS) and disability (ODI), with improved quality of life (EQ-5D).
• Greater correction of pelvic incidence-lumbar lordosis mismatch correlated with better outcomes.

Conclusions:

• BE-TLIF with a single bullet-type expandable cage demonstrates favorable one-year outcomes.
• The technique provides effective sagittal correction and fusion rates for short-segment lumbar fusion.
• This approach supports the non-inferiority of expandable cages in BE-TLIF procedures.