Lai Ta-Wei, Chen Po-Ming, Li Chi-Huan, Chan Cheng-Jung, Cheng Po-Cheng, Huang Chun-Hsien, Kuo Li-Ching, Ku Ming-Chou
Department of Orthopedics, Chang Bing Show Chwan Memorial Hospital, Changhua County, Taiwan, Republic of China.
Department of Orthopedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan, Republic of China.
Medicine (Baltimore). 2025 Aug 22;104(34):e44042. doi: 10.1097/MD.0000000000044042.
Expandable cage is designed to facilitate cage insertion from small posterior inlet and minimize neural structure over-traction, at the same time, to expand the disk space as large as possible while prevent posterior endplate breakage during cage insertion in transforaminal lumbar interbody fusion surgery. The purpose of this study is to compare radiologic and clinical outcomes between expandable and static cage, and complications of the 2 groups. Between January 2021 and January 2023, patients with lumbar spine degeneration or herniation of intervertebral disk accepting transforaminal lumbar interbody fusion surgery were included in the study. Anterior segmental height, posterior segmental height, and Cobb angle of fusion segment were recorded. These patients were divided to expandable and static group. Both group of patients were recorded of Oswestry Disability Index, back pain visual analogue score, and leg pain visual analogue score. Expandable cage group was 101 patients and static cage group was 103 patients. After operation, both groups had improvement of anterior and posterior disk height (P < .001). Fusion segmental lordosis increased after surgery in both group (P < .001). The improvement of lordosis was better in expandable group. Cages posterior migration (P < .01), cage subsidence (P = .03), and screws loosening (P = .03) were higher in static group. Expandable group had more cage breakage (P = .04),. Both groups had decreased Oswestry Disability Index and leg pain after operation (P < .001). Expandable group had better leg pain relief. Both groups had more back pain at postoperative stage. The back pain decreased at postoperative 6-month, 1-year, and 2-year gradually. Expandable group had less back pain after surgery. Expandable cage had less cage migration and cage subsidence than static cage. At the same time, expandable cage had better functional outcome than static cage. However, cage breakage rate was higher in expandable cage.
可扩张椎间融合器的设计目的是便于从小的后路入口插入椎间融合器，并尽量减少对神经结构的过度牵拉，同时在经椎间孔腰椎椎间融合手术中插入椎间融合器时尽可能扩大椎间盘间隙，防止终板后端破裂。本研究的目的是比较可扩张椎间融合器和静态椎间融合器的影像学和临床结果，以及两组的并发症。2021年1月至2023年1月，纳入接受经椎间孔腰椎椎间融合手术的腰椎退变或椎间盘突出患者。记录融合节段的前节段高度、后节段高度和Cobb角。这些患者被分为可扩张组和静态组。记录两组患者的Oswestry功能障碍指数、背痛视觉模拟评分和腿痛视觉模拟评分。可扩张椎间融合器组101例患者，静态椎间融合器组103例患者。术后，两组的椎间盘前后高度均有改善（P < 0.001）。两组术后融合节段的前凸均增加（P < 0.001）。可扩张组的前凸改善更好。静态组的椎间融合器向后移位（P < 0.01）、椎间融合器下沉（P = 0.03）和螺钉松动（P = 0.03）发生率更高。可扩张组的椎间融合器断裂更多（P = 0.04）。两组术后Oswestry功能障碍指数和腿痛均降低（P < 0.001）。可扩张组的腿痛缓解更好。两组术后背痛均较多。术后6个月、1年和2年背痛逐渐减轻。可扩张组术后背痛较少。可扩张椎间融合器比静态椎间融合器的椎间融合器移位和下沉更少。同时，可扩张椎间融合器的功能结果比静态椎间融合器更好。然而，可扩张椎间融合器的椎间融合器断裂率更高。
