Seaton Margaret Patricia Calder, Hirshman Brian Robert, Kim Timothy Yushin, Pham Martin Huy
School of Medicine, University of California, San Diego, La Jolla, CA, USA.
Department of Neurological Surgery, University of California, San Diego, San Diego, CA, USA.
Asian Spine J. 2025 Aug 11. doi: 10.31616/asj.2025.0032.
A single surgeon, retrospective case series.
This study aimed to compare the radiological outcomes after using expandable versus static cages in oblique lumbar interbody fusion (OLIF).
OLIF enables access to the spine while avoiding the anterior vessels and psoas muscles via a retroperitoneal corridor. Static cages have been used in this approach; however, they present with limitations, including repeated trialing, resulting in endplate violation and implant subsidence.
Patients who underwent OLIF (n=86) were divided into expandable (n=39) and static cage (n=47) groups. Radiographic data were then analyzed preoperatively and postoperatively, including immediate, 3 months, and the most recent follow-up.
Cage type predicted the incidence of subsidence, with expandable cages associated with 4.00 and 2.43 fewer instances of subsidence compared with static cages at the postoperative and most recent time points (p<0.05). Cage type was a significant predictor of the change in height in both the posterior disk and foraminal height (FH) models. Expandable cages were associated with improved posterior disk height (DH) expansion at all three time points (1.24 mm, 0.88 mm, and 1.85 mm, respectively; p<0.01), and with larger FH increases at the 3 months postoperatively and most recent follow-up (1.12 mm, 0.40 mm, and 1.28 mm, respectively; p=0.096, 0.016, and 0.030). The expandable cage type was associated with improvement (3.46°, 3.12°, and 3.36°; p<0.01, 0.05, and 0.08, respectively) at the postoperative and 3-month time points when predicting the change in segmental lordosis. No statistically significant differences were found between the groups in disk angle and lumbar lordosis measurements or baseline demographics.
The results of this study indicate that both static and expandable cages result in radiographic improvement in posterior DH, segmental lordosis, and FH when used in OLIF. Expandable cages may demonstrate certain advantages over static cages due to lower implant subsidence instances and the greater posterior disk and FH expansion, thereby providing preliminary evidence to support the superiority of expandable cages in OLIF procedures.
单外科医生的回顾性病例系列研究。
本研究旨在比较斜外侧腰椎椎间融合术（OLIF）中使用可扩张椎间融合器与静态椎间融合器后的影像学结果。
OLIF可通过腹膜后通道进入脊柱，同时避免损伤前方血管和腰大肌。静态椎间融合器已应用于该手术；然而，它们存在局限性，包括反复试模，导致终板损伤和植入物下沉。
接受OLIF手术的患者（n = 86）分为可扩张椎间融合器组（n = 39）和静态椎间融合器组（n = 47）。然后对术前和术后的影像学数据进行分析，包括即刻、术后3个月及最近一次随访。
椎间融合器类型可预测下沉发生率，与静态椎间融合器相比，可扩张椎间融合器在术后及最近时间点下沉发生率分别减少4.00例和2.43例（p < 0.05）。椎间融合器类型是后椎间盘高度和椎间孔高度（FH）模型中高度变化的显著预测因素。可扩张椎间融合器在所有三个时间点均与后椎间盘高度（DH）扩张改善相关（分别为1.24 mm、0.88 mm和1.85 mm；p < 0.01），且在术后3个月及最近一次随访时椎间孔高度增加更大（分别为1.12 mm、0.40 mm和1.28 mm；p = 0.096、0.016和0.030）。在预测节段性前凸变化时，可扩张椎间融合器类型在术后及3个月时间点与改善相关（分别为3.46°、3.12°和3.36°；p < 0.01、0.05和0.08）。两组在椎间盘角度、腰椎前凸测量或基线人口统计学方面未发现统计学显著差异。
本研究结果表明，在OLIF手术中使用静态和可扩张椎间融合器均可使后DH、节段性前凸和FH在影像学上得到改善。可扩张椎间融合器可能比静态椎间融合器具有某些优势，因为植入物下沉情况较少，后椎间盘和FH扩张更大，从而为支持可扩张椎间融合器在OLIF手术中的优越性提供了初步证据。
