Our Summary

The research paper discusses a type of back surgery called transforaminal lumbar interbody fusion (TLIF). In this surgery, doctors often use a tool called a cage to help support the space between the spine’s discs. Traditionally, they have used static cages that don’t change size. However, new technologies have introduced adjustable cages that can expand in one direction (uniplanar expandable cages or UECs) or two directions (bi-planar expandable cages or BECs). The idea is that these adjustable cages might prevent complications after surgery.

However, since BECs are relatively new, there haven’t been any studies comparing them to UECs. This paper looks at existing research that used UECs and/or BECs in back surgeries. The main outcomes they looked at were whether the surgery caused any subsidence (sinking or settling of the spine) and how successful the fusion (joining of two bones into one) was. They also looked at secondary outcomes like back and leg pain, disability, and other complications.

They analyzed 15 studies, 3 of which used BECs. They found a significant difference in the success of fusion between UECs and BECs, with BECs having a higher rate. However, they warn that this result should be taken with caution as there were no studies directly comparing UECs and BECs. They didn’t find any other significant differences. They suggest that more direct comparisons between UECs and BECs are needed to understand any potential differences.

FAQs

  1. What is transforaminal lumbar interbody fusion (TLIF) surgery and what tools are used in it?
  2. What are the main differences between uniplanar expandable cages (UECs) and bi-planar expandable cages (BECs) in TLIF surgery?
  3. What evidence is there to suggest that BECs might be more effective than UECs in TLIF surgery?

Doctor’s Tip

A helpful tip a doctor might tell a patient about lumbar fusion using adjustable cages is to discuss with them the potential benefits of using bi-planar expandable cages (BECs) compared to uniplanar expandable cages (UECs). While research has shown a higher success rate of fusion with BECs, it is important to note that direct comparisons between the two types of cages are limited. Patients should be aware of the potential advantages of BECs and discuss with their surgeon the best option for their specific case.

Suitable For

Patients who are typically recommended lumbar fusion surgery include those with:

  1. Degenerative disc disease
  2. Disc herniation
  3. Spondylolisthesis
  4. Spinal stenosis
  5. Instability of the spine
  6. Failed back surgery syndrome

These patients may experience symptoms such as chronic back pain, leg pain, numbness or weakness, and difficulty walking or standing. They may have tried conservative treatments such as physical therapy, medications, and injections with little to no relief. Lumbar fusion surgery may be recommended when these conservative treatments have not been effective in improving the patient’s symptoms.

Timeline

Before lumbar fusion:

  • Patient experiences chronic back pain, leg pain, and/or numbness
  • Patient undergoes imaging tests such as X-rays, MRI, or CT scans to determine the cause of their symptoms
  • Patient may undergo conservative treatments such as physical therapy, pain management, or injections to alleviate symptoms
  • If conservative treatments are unsuccessful, patient and their doctor may decide on lumbar fusion surgery

After lumbar fusion:

  • Patient undergoes pre-operative evaluations and tests to ensure they are a good candidate for surgery
  • Patient undergoes lumbar fusion surgery, which involves removing damaged disc material, inserting a cage or other support device, and fusing the vertebrae together
  • Patient is monitored in the hospital for a few days post-surgery
  • Patient undergoes physical therapy and rehabilitation to regain strength and mobility
  • Patient follows up with their doctor for post-operative appointments to monitor healing and address any complications
  • Patient may experience improvements in back pain, leg pain, and overall function over time as the fusion heals and stabilizes the spine.

What to Ask Your Doctor

Some questions a patient should ask their doctor about lumbar fusion using adjustable cages include:

  1. What type of adjustable cage will be used in my surgery, a uniplanar expandable cage (UEC) or a bi-planar expandable cage (BEC)?
  2. What are the potential benefits of using an adjustable cage compared to a static cage in my specific case?
  3. What are the potential risks or complications associated with using an adjustable cage in lumbar fusion surgery?
  4. Have you had experience using adjustable cages in previous surgeries, and what has been the success rate?
  5. How does the success rate of fusion compare between UECs and BECs, based on the available research?
  6. Are there any specific factors about my condition or anatomy that make one type of adjustable cage more suitable for me than the other?
  7. What is the expected timeline for recovery and rehabilitation after lumbar fusion using an adjustable cage?
  8. Are there any alternative treatment options to lumbar fusion that I should consider before moving forward with surgery?
  9. What follow-up appointments and monitoring will be necessary after the surgery to ensure the fusion is successful and there are no complications?
  10. Are there any lifestyle changes or precautions I should take after surgery to support the healing process and prevent complications?

Reference

Authors: Matsoukas S, Karabacak M, Margetis K. Journal: Neurosurg Rev. 2024 Jan 8;47(1):36. doi: 10.1007/s10143-023-02277-w. PMID: 38191751