Our Summary

This research paper is essentially a review of the scientific literature on the use of expandable cages in spinal fusion surgeries. These cages, which have been in use since the early 2000s, are used to stabilize the spine and facilitate the healing process during less invasive spinal surgeries. However, not all cages are the same; they can differ in terms of their shape, size, material, and other features.

The purpose of this study was to examine the range of design features in these cages and determine which features are associated with better surgical outcomes. The researchers followed established guidelines for conducting systematic reviews, and they searched two major databases for relevant articles. They specifically looked for articles written in English that provided enough detail to link a specific cage design to patient outcomes.

Out of 387 articles that were initially identified, only 49 met all the criteria for inclusion in the review. The researchers found that the design of the cage does make a difference in patient outcomes. In particular, cages that are rectangular, made of titanium, and have the ability to expand both medially-laterally and vertically, and that allow for continuous adjustment of the spine’s natural curvature (lordosis), were associated with significantly better patient-reported outcomes.

The researchers also found that the surgical approach and location of the surgery can affect patient outcomes. This suggests that there are other factors at play that can influence the success of the surgery.

In conclusion, the researchers recommend that we stop thinking of expandable cage technologies as all the same. They argue that the specific design features of these devices can impact long-term patient outcomes. Therefore, they suggest that devices should be categorized based on their design features. This could help identify which characteristics are associated with better outcomes more quickly.

FAQs

  1. What are expandable cages used for in spinal fusion surgeries?
  2. How does the design of the expandable cages impact patient outcomes in spinal fusion surgeries?
  3. What other factors can influence the success of spinal fusion surgeries using expandable cages?

Doctor’s Tip

A helpful tip a doctor might tell a patient about spinal fusion is to follow the post-operative care instructions carefully. This may include avoiding heavy lifting, getting plenty of rest, and attending physical therapy sessions to aid in recovery and strengthen the muscles surrounding the spine. It is also important to maintain a healthy lifestyle with regular exercise and a balanced diet to support the healing process. Lastly, keep in regular communication with your healthcare provider to address any concerns or complications that may arise during the recovery period.

Suitable For

Patients who are typically recommended for spinal fusion surgery include those with:

  1. Degenerative disc disease: This condition occurs when the discs between the vertebrae deteriorate, causing pain and instability in the spine.

  2. Scoliosis: This is a condition in which the spine curves abnormally, leading to pain and discomfort.

  3. Spinal stenosis: This is a narrowing of the spinal canal, which can put pressure on the spinal cord and nerves, causing pain and numbness.

  4. Herniated discs: When the soft inner material of a disc protrudes through the tough outer layer, it can press on nearby nerves and cause pain.

  5. Spondylolisthesis: This is a condition in which one vertebra slips forward over the one below it, causing instability and pain.

  6. Spinal fractures: Fractures in the vertebrae may require spinal fusion to stabilize the spine and promote healing.

Overall, patients who have not responded to conservative treatments such as physical therapy, medications, and injections may be recommended for spinal fusion surgery. Additionally, those who have significant pain, weakness, or numbness in the back or extremities that affect their daily activities and quality of life may also be candidates for spinal fusion.

Timeline

Before spinal fusion surgery:

  • Patient undergoes a series of diagnostic tests, such as X-rays, MRIs, and CT scans, to determine the cause of their back pain and to assess the condition of their spine.
  • Patient may try conservative treatments, such as physical therapy, medications, and injections, to manage their pain before considering surgery.
  • Patient meets with a surgeon to discuss the risks and benefits of spinal fusion surgery and to determine if they are a suitable candidate for the procedure.

After spinal fusion surgery:

  • Patient typically stays in the hospital for a few days to recover from the surgery and to be monitored for any complications.
  • Patient may need to wear a brace to support their spine as it heals.
  • Patient undergoes physical therapy to regain strength and mobility in their back.
  • Patient may experience some pain and discomfort as they recover from the surgery, which can be managed with medications.
  • Patient follows up with their surgeon for regular check-ups to monitor their progress and address any concerns.

What to Ask Your Doctor

Some questions a patient should ask their doctor about spinal fusion surgery with expandable cages include:

  1. What specific type of expandable cage will be used in my surgery and why?
  2. How does the design of the cage chosen for my surgery compare to other options available?
  3. What materials is the cage made of and how does this impact the success of the surgery?
  4. Will the cage be able to adjust both medially-laterally and vertically during the surgery?
  5. Will the cage allow for continuous adjustment of my spine’s natural curvature (lordosis) post-surgery?
  6. How does the design of the cage chosen for my surgery impact long-term patient outcomes?
  7. Are there any specific factors about my case that make a certain type of cage more appropriate for me?
  8. How does the surgical approach and location of the surgery impact the choice of expandable cage for spinal fusion?
  9. Are there any potential risks or complications associated with the specific type of cage being used in my surgery?
  10. Can you provide me with any research or literature that supports the use of the specific type of expandable cage for my spinal fusion surgery?

Reference

Authors: Orr D, Anderson R, Jensen A, Peterson T, Edwards J, Bowden AE. Journal: Spine J. 2025 Aug;25(8):1773-1793. doi: 10.1016/j.spinee.2025.01.013. Epub 2025 Feb 1. PMID: 39900249