- Email: [email protected]
Rescue Implantation of Expandable Cages for Severe Osteolysis and Cage Dislocation in the Lumbosacral Junction
Accepted Manuscript Rescue implantation of expandable cages for severe osteolysis and cage dislocation in the lumbosacral junction Bawarjan Schatlo, Veit Rohde, Volodymyr Solomiichuk, Kajetan von Eckardstein, Timo Behm PII:
S1878-8750(17)31326-8
DOI:
10.1016/j.wneu.2017.08.029
Reference:
WNEU 6279
To appear in:
World Neurosurgery
Received Date: 2 June 2017 Revised Date:
3 August 2017
Accepted Date: 4 August 2017
Please cite this article as: Schatlo B, Rohde V, Solomiichuk V, von Eckardstein K, Behm T, Rescue implantation of expandable cages for severe osteolysis and cage dislocation in the lumbosacral junction, World Neurosurgery (2017), doi: 10.1016/j.wneu.2017.08.029. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
ACCEPTED MANUSCRIPT
Rescue implantation of expandable cages for severe osteolysis and cage dislocation in the lumbosacral junction
RI PT
Bawarjan Schatlo, Veit Rohde, Volodymyr Solomiichuk, Kajetan von Eckardstein, Timo Behm
M AN U
Correspondence to: Volodymyr Solomiichuk Department of Neurosurgery University Hospital Göttingen Georg-August-University [email protected] Phone: +49-551-399773 Fax: +49-551-398794
SC
Department of Neurosurgery, University Hospital Göttingen, Georg-August-University
AC C
EP
TE D
Key words: Osteoporosis, osteolysis, implant loosening, pedicle screws
ACCEPTED MANUSCRIPT
Abstract
M AN U
SC
RI PT
Osteolysis and implant loosening represent a commonly encountered problem after spinal instrumentation. We herein present the case of a patient who had previously undergone a posterior lumbar interbody fusion procedure (PLIF). However, fusion did not occur and a secondary cage dislocation led to an impingement of the L5 nerve root with severe radiculopathy. Revision surgery was performed. Intraoperatively, we found that osteolysis was so severe that conventional cages did not fill the void to allow for sufficient anterior column support. Therefore, we used expandable transforaminal lumbar interbody fusion (TLIF) cages and implanted them bilaterally to replace the dislodged PLIF cages. Clinical follow-up was uneventful. Imaging showed satisfactory cage position and fusion at one year. In summary, we propose the use of cages with the ability of ventral distraction in similar rescue interventions with cage-dislocation and bone resorption. This may prevent a second surgery via a ventral approach.
Introduction
AC C
Case Report
EP
TE D
Osteolysis and implant loosening represent a commonly encounterd problem after spinal instrumentation6. Dislocation of an intervertebral cage may potentially lead to compression of nerve roots or the dural sac and requires urgent revision9. However, in case of severe osteolysis, it may be difficult to replace the bony defect with a sufficiently large cage. Therefore, a retroperitoneal ventral revision surgery may be indicated in some cases while salvage procedures via a dorsal approach are often insufficient since they do not provide anterior column support. We herein present the use of expandable TLIF cages to address severe osteolysis after a previous posterior lumbar interbody fusion (PLIF) with cage migration.
A 74-year old patient who had previously undergone PLIF for degenerative spondylolisthesis at the L5-S1 level presented with L5-radiculopathy on the left side. Imaging showed severe retropulsion of both cages impinging the L5 nerve roots at the foraminal level bilaterally (figure 1). A nerve root block for the L5-root on the right side provided temporary pain relief which confirmed our suspicion of nerve root compression due to cage retropulsion. Therefore, we elected to perform surgery to replace the dislocated cages and screws. We felt a dorsal approach was necessary to inspect the impinged L5 nerve root and to revise the screws. On the other hand, osteolysis of L5 around the cages was extensive. Surgery
ACCEPTED MANUSCRIPT Intraoperatively, we replaced the initially placed pedicle screws with larger screws. Afterwards, we performed additional microsurgical decompression including arthrectomy and were able to visualize the L5 nerve roots. As expected, the left L5 nerve root was impinged by dorsal cage migration. After gently retracting and protecting the nerve root with a blunt retractor blade, the cages (PEEK) were dislodged and extracted using a wiggling motion with a dissector and a hook under slight traction.
SC
RI PT
The void created by bone resorption was so extensive that we were unable to tightly secure any conventional PLIF-cages into the intervertebral space. We deployed a special type of expandable titanium TLIF-cage (Spontech, Germany) to replace the dislocated PLIF-cages. After insertion through a PLIF-trajectory, the anterior height of the cage (12mm) was raised to 17mm (figure 2). This was achieved using a T-shaped handle with a screw-driver tip which is rotated 90° (figure 3). This rotating motion turns a rectangular titan bar into the vertical position, thereby expanding the “forceps” of the cage blades.
M AN U
The radiculopathy resolved postoperatively and the patient was mobilized on day 1 and remained relieved of his symptoms until one year postoperatively. Imaging showed a satisfactory contact area between bone and cage on postoperative day 1 as well as fusion at L5-S1 with an anterior bone bridge at one year follow-up (figure 1).
Discussion
AC C
EP
TE D
In the presented case, we achieved a satisfactory result by “misusing” TLIF-cages as salvage PLIFs. Their ability to expand in situ allowed us to fill the interbody space despite significant bone erosion. We discussed the possibility of extending the construct to L5 to allow for an L5corpectomy with subsequent vertebral body replacement. However, we felt that at this point this was too invasive. Alternatively, an anterior lumbar interbody fusion-technique, e.g. with an iliac crest graft or a dedicated cage would have been possible and probably would have yielded the same long-term fusion result. However, it would have added the risk of an anterior approach. Finally, using the dorsal approach as we did, we could have filled the interbody space with iliac crest graft bone or artificial matrix to promote fusion. In this case, we used autologous bone only. The development of expandable interbody cages was attempted in the late 90ies. Almost 20 years later there is a plethora of different devices: Some cages, like the one used in this patient, are designed to restore lordosis by craniocaudal expansion3,4. Other systems are developed to improve stability and promote fusion by allowing for a larger footprint by expanding laterally4,11. While the majority are made mainly of titanium alloys2-5,8,11, likely for reasons of stability, some polyaryl-ether-ether-ketone (PEEK) devices1 are available as well. Potential complications of larger expandable cages include dorsal retropulsion, ventral migration and nerve root impingement due to their size. Therefore, care must be taken to create space by a sufficient arthrotomy. Moreover, revision scenarios other than the one presented may require a higher degree of root manipulation. In such cases, a secondary ventral approach should be favored.
ACCEPTED MANUSCRIPT
Conclusion
RI PT
In summary, we propose the use of cages with the ability of ventral distraction in similar rescue interventions with cage-dislocation and bone resorption. This may prevent a second surgery via a ventral approach.
References
5.
6. 7.
8.
9.
10.
11.
SC
M AN U
4.
TE D
3.
EP
2.
Alimi M, Shin B, Macielak M, Hofstetter CP, Njoku I, Jr., Tsiouris AJ, et al: Expandable Polyaryl-Ether-Ether-Ketone Spacers for Interbody Distraction in the Lumbar Spine. Global Spine J 5:169-178, 2015 Barrett-Tuck R, Del Monaco D, Block JE: One and two level posterior lumbar interbody fusion (PLIF) using an expandable, stand-alone, interbody fusion device: a VariLift(R) case series. J Spine Surg 3:9-15, 2017 Boktor J, Verghese N: The expandable transforaminal lumbar interbody fusion— maximum 3 year follow up. The Spine Journal, Supplement:56, 2017 Cannestra AF, Peterson MD, Parker SR, Roush TF, Bundy JV, Turner AW: MIS Expandable Interbody Spacers: A Literature Review and Biomechanical Comparison of an Expandable MIS TLIF With Conventional TLIF and ALIF. Spine (Phila Pa 1976) 41 Suppl 8:S44-49, 2016 Folman Y, Lee SH, Silvera JR, Gepstein R: Posterior lumbar interbody fusion for degenerative disc disease using a minimally invasive B-twin expandable spinal spacer: a multicenter study. J Spinal Disord Tech 16:455-460, 2003 Galbusera F, Volkheimer D, Reitmaier S, Berger-Roscher N, Kienle A, Wilke HJ: Pedicle screw loosening: a clinically relevant complication? Eur Spine J 24:1005-1016, 2015 Kale A, Oz, II, Onk A, Kalayci M, Buyukuysal C: Unilaterally posterior lumbar interbody fusion with double expandable peek cages without pedicle screw support for lumbar disc herniation. Neurol Neurochir Pol 51:53-59, 2017 Kim JW, Park HC, Yoon SH, Oh SH, Roh SW, Rim DC, et al: A Multi-center Clinical Study of Posterior Lumbar Interbody Fusion with the Expandable Stand-alone Cage (Tyche(R) Cage) for Degenerative Lumbar Spinal Disorders. J Korean Neurosurg Soc 42:251257, 2007 Kimura H, Shikata J, Odate S, Soeda T, Yamamura S: Risk factors for cage retropulsion after posterior lumbar interbody fusion: analysis of 1070 cases. Spine (Phila Pa 1976) 37:1164-1169, 2012 Liu E, Yin Q, Guo D: Long-term follow-up study on expandable cage in treatment of degenerative lumbar disc disease. Chinese Journal of Reparative and Reconstructive Surgery 28:540-543, 2014 Morgenstern R, Morgenstern C: Percutaneous Transforaminal Lumbar Interbody Fusion (pTLIF) with a Posterolateral Approach for the Treatment of Denegerative Disk Disease: Feasibility and Preliminary Results. Int J Spine Surg 9:41, 2015
AC C
1.
ACCEPTED MANUSCRIPT
EP
TE D
M AN U
SC
RI PT
Trivino Lopez A, Romo Contreras I, Rubio Gonzalel A, Garcia Garcia J, Hernandez Vaquero D: Lumbar interbody fusion using expansive intersomatic cages. Rev Esp Cir Ortop Traumatol 46:42-46, 2002
AC C
12.
M AN U
SC
RI PT
ACCEPTED MANUSCRIPT
AC C
EP
TE D
Figure 1: Preoperatively, cage markers (arrow) indicate retropulsion of the cage impinging the L5-foramen. After revision surgery (Postoperative), expandable cages with an anterior height of 17mm (at insertion: 12mm) can be seen. With friendly permission from Spontech Medical AG, Stuttgart, Germany.
Figure 2: During insertion, the TLIF cage is only 12mm high. Its anterior height can be increased to 17mm once it is in situ by a 90° degree turn on the blue interior metal component. With friendly permission from Spontech Medical AG, Stuttgart, Germany.
M AN U
SC
RI PT
ACCEPTED MANUSCRIPT
AC C
EP
TE D
Figure 3: Once inserted in the collapsed state (right upper circle), the insertion device (left) is left in place. The upper handle is turned 90° and thereby induces expansion of the anterior portion of the cage (right lower circle). The insertion device can then unscrewed and removed. With friendly permission from Spontech Medical AG, Stuttgart, Germany.
ACCEPTED MANUSCRIPT Table 1: Overview of expandable lumbar interbody fusion devices
8
Triviño López et al. 12 2002 Liu et al., 2014
10
Kale et al., 20177
Alimi et al., 2015
1
Mechanism of expansion
Wenzel Spine, Austin, TX, USA
PLIF
Disc-OTech
Titaniu m
Disc-O-Tech Medical Technologies Ltd., Herzliya, Israel
PLIF
Interior component can be advanced in situ, leading to contentric, mostly anterior widening of cage The cage is inserted in the collapsed state which is a 5mm tube., It expands to up to 15mm
Tyche
Titaniu m
Korea (N/A)
TLIF
LIFEC
Titaniu m
PLIF
N/A
N/A
OrtoMedimatec, Valladolid, Spain China (N/A)
Double expanda able PLIF cages StaXx XD
PEEK
PEEK
Caliber, Rise, Altera
Globus Medical
AC C
EP
Boktor and Verghese, 3 2017
Property
Cannestra et al., 4 2016
Cannestra et al., 4 2016
Cannestra et al., 4 2016
mediallateral expanda ble (MLX™) LATIS
Opticag e
(NuVasi ve, Inc., San Diego, CA) (Globus Medical , Inc., Audubo n, PA) (Interve ntional Spine, Inc., Irvine,
RI PT
Kim et al., 2007
5
Manufacturer
Advancement of a sled within the cage leads to increased lordosis by 4° N/A
SC
Folman et al., 2003
Materi al Titaniu m
M AN U
Barret-Tuck et al., 2 2017
Device name VariLift
Disc replacem ent Unilatera l PLIF
N/A
TLIF
7 to 15mm in situ expansion
PLIF/TLIF
Expansion in situ
Altera: Titanium (external) PEEK, cobalt chromium molybdenium alloy (internal) Titanium alloy
TLIF
Medio-lateral expansion to hexagonal surface
Titanium alloy
TLIF
Expands to square shape
Titanium
TLIF
Expands in situ with a wedge-induced mechanism
N/A
(Spine Wave, Inc., Shelton, CT, United States) Rise, Caliber:: Titanium, PEEK
TE D
Author, year
N/A
ACCEPTED MANUSCRIPT
Morgenstern et al., 11 2015
FLXfit 3D
CA) (Stryker Spine, Allenda le, NJ) Expandi ng Orthop edics, Atlanta, GA 30326 USA
Titanium
TLIF
Hydraulic; Steerable and expandable in situ
Titanium
TLIF
Articulated device for wider footprint
RI PT
AccuLIF
AC C
EP
TE D
M AN U
SC
Cannestra et al., 4 2016
ACCEPTED MANUSCRIPT TLIF - Transforaminal Lumbar Interbody Fusion
AC C
EP
TE D
M AN U
SC
RI PT
PLIF - posterior lumbar interbody fusion
S1878-8750(17)31326-8
DOI:
10.1016/j.wneu.2017.08.029
Reference:
WNEU 6279
To appear in:
World Neurosurgery
Received Date: 2 June 2017 Revised Date:
3 August 2017
Accepted Date: 4 August 2017
Please cite this article as: Schatlo B, Rohde V, Solomiichuk V, von Eckardstein K, Behm T, Rescue implantation of expandable cages for severe osteolysis and cage dislocation in the lumbosacral junction, World Neurosurgery (2017), doi: 10.1016/j.wneu.2017.08.029. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
ACCEPTED MANUSCRIPT
Rescue implantation of expandable cages for severe osteolysis and cage dislocation in the lumbosacral junction
RI PT
Bawarjan Schatlo, Veit Rohde, Volodymyr Solomiichuk, Kajetan von Eckardstein, Timo Behm
M AN U
Correspondence to: Volodymyr Solomiichuk Department of Neurosurgery University Hospital Göttingen Georg-August-University [email protected] Phone: +49-551-399773 Fax: +49-551-398794
SC
Department of Neurosurgery, University Hospital Göttingen, Georg-August-University
AC C
EP
TE D
Key words: Osteoporosis, osteolysis, implant loosening, pedicle screws
ACCEPTED MANUSCRIPT
Abstract
M AN U
SC
RI PT
Osteolysis and implant loosening represent a commonly encountered problem after spinal instrumentation. We herein present the case of a patient who had previously undergone a posterior lumbar interbody fusion procedure (PLIF). However, fusion did not occur and a secondary cage dislocation led to an impingement of the L5 nerve root with severe radiculopathy. Revision surgery was performed. Intraoperatively, we found that osteolysis was so severe that conventional cages did not fill the void to allow for sufficient anterior column support. Therefore, we used expandable transforaminal lumbar interbody fusion (TLIF) cages and implanted them bilaterally to replace the dislodged PLIF cages. Clinical follow-up was uneventful. Imaging showed satisfactory cage position and fusion at one year. In summary, we propose the use of cages with the ability of ventral distraction in similar rescue interventions with cage-dislocation and bone resorption. This may prevent a second surgery via a ventral approach.
Introduction
AC C
Case Report
EP
TE D
Osteolysis and implant loosening represent a commonly encounterd problem after spinal instrumentation6. Dislocation of an intervertebral cage may potentially lead to compression of nerve roots or the dural sac and requires urgent revision9. However, in case of severe osteolysis, it may be difficult to replace the bony defect with a sufficiently large cage. Therefore, a retroperitoneal ventral revision surgery may be indicated in some cases while salvage procedures via a dorsal approach are often insufficient since they do not provide anterior column support. We herein present the use of expandable TLIF cages to address severe osteolysis after a previous posterior lumbar interbody fusion (PLIF) with cage migration.
A 74-year old patient who had previously undergone PLIF for degenerative spondylolisthesis at the L5-S1 level presented with L5-radiculopathy on the left side. Imaging showed severe retropulsion of both cages impinging the L5 nerve roots at the foraminal level bilaterally (figure 1). A nerve root block for the L5-root on the right side provided temporary pain relief which confirmed our suspicion of nerve root compression due to cage retropulsion. Therefore, we elected to perform surgery to replace the dislocated cages and screws. We felt a dorsal approach was necessary to inspect the impinged L5 nerve root and to revise the screws. On the other hand, osteolysis of L5 around the cages was extensive. Surgery
ACCEPTED MANUSCRIPT Intraoperatively, we replaced the initially placed pedicle screws with larger screws. Afterwards, we performed additional microsurgical decompression including arthrectomy and were able to visualize the L5 nerve roots. As expected, the left L5 nerve root was impinged by dorsal cage migration. After gently retracting and protecting the nerve root with a blunt retractor blade, the cages (PEEK) were dislodged and extracted using a wiggling motion with a dissector and a hook under slight traction.
SC
RI PT
The void created by bone resorption was so extensive that we were unable to tightly secure any conventional PLIF-cages into the intervertebral space. We deployed a special type of expandable titanium TLIF-cage (Spontech, Germany) to replace the dislocated PLIF-cages. After insertion through a PLIF-trajectory, the anterior height of the cage (12mm) was raised to 17mm (figure 2). This was achieved using a T-shaped handle with a screw-driver tip which is rotated 90° (figure 3). This rotating motion turns a rectangular titan bar into the vertical position, thereby expanding the “forceps” of the cage blades.
M AN U
The radiculopathy resolved postoperatively and the patient was mobilized on day 1 and remained relieved of his symptoms until one year postoperatively. Imaging showed a satisfactory contact area between bone and cage on postoperative day 1 as well as fusion at L5-S1 with an anterior bone bridge at one year follow-up (figure 1).
Discussion
AC C
EP
TE D
In the presented case, we achieved a satisfactory result by “misusing” TLIF-cages as salvage PLIFs. Their ability to expand in situ allowed us to fill the interbody space despite significant bone erosion. We discussed the possibility of extending the construct to L5 to allow for an L5corpectomy with subsequent vertebral body replacement. However, we felt that at this point this was too invasive. Alternatively, an anterior lumbar interbody fusion-technique, e.g. with an iliac crest graft or a dedicated cage would have been possible and probably would have yielded the same long-term fusion result. However, it would have added the risk of an anterior approach. Finally, using the dorsal approach as we did, we could have filled the interbody space with iliac crest graft bone or artificial matrix to promote fusion. In this case, we used autologous bone only. The development of expandable interbody cages was attempted in the late 90ies. Almost 20 years later there is a plethora of different devices: Some cages, like the one used in this patient, are designed to restore lordosis by craniocaudal expansion3,4. Other systems are developed to improve stability and promote fusion by allowing for a larger footprint by expanding laterally4,11. While the majority are made mainly of titanium alloys2-5,8,11, likely for reasons of stability, some polyaryl-ether-ether-ketone (PEEK) devices1 are available as well. Potential complications of larger expandable cages include dorsal retropulsion, ventral migration and nerve root impingement due to their size. Therefore, care must be taken to create space by a sufficient arthrotomy. Moreover, revision scenarios other than the one presented may require a higher degree of root manipulation. In such cases, a secondary ventral approach should be favored.
ACCEPTED MANUSCRIPT
Conclusion
RI PT
In summary, we propose the use of cages with the ability of ventral distraction in similar rescue interventions with cage-dislocation and bone resorption. This may prevent a second surgery via a ventral approach.
References
5.
6. 7.
8.
9.
10.
11.
SC
M AN U
4.
TE D
3.
EP
2.
Alimi M, Shin B, Macielak M, Hofstetter CP, Njoku I, Jr., Tsiouris AJ, et al: Expandable Polyaryl-Ether-Ether-Ketone Spacers for Interbody Distraction in the Lumbar Spine. Global Spine J 5:169-178, 2015 Barrett-Tuck R, Del Monaco D, Block JE: One and two level posterior lumbar interbody fusion (PLIF) using an expandable, stand-alone, interbody fusion device: a VariLift(R) case series. J Spine Surg 3:9-15, 2017 Boktor J, Verghese N: The expandable transforaminal lumbar interbody fusion— maximum 3 year follow up. The Spine Journal, Supplement:56, 2017 Cannestra AF, Peterson MD, Parker SR, Roush TF, Bundy JV, Turner AW: MIS Expandable Interbody Spacers: A Literature Review and Biomechanical Comparison of an Expandable MIS TLIF With Conventional TLIF and ALIF. Spine (Phila Pa 1976) 41 Suppl 8:S44-49, 2016 Folman Y, Lee SH, Silvera JR, Gepstein R: Posterior lumbar interbody fusion for degenerative disc disease using a minimally invasive B-twin expandable spinal spacer: a multicenter study. J Spinal Disord Tech 16:455-460, 2003 Galbusera F, Volkheimer D, Reitmaier S, Berger-Roscher N, Kienle A, Wilke HJ: Pedicle screw loosening: a clinically relevant complication? Eur Spine J 24:1005-1016, 2015 Kale A, Oz, II, Onk A, Kalayci M, Buyukuysal C: Unilaterally posterior lumbar interbody fusion with double expandable peek cages without pedicle screw support for lumbar disc herniation. Neurol Neurochir Pol 51:53-59, 2017 Kim JW, Park HC, Yoon SH, Oh SH, Roh SW, Rim DC, et al: A Multi-center Clinical Study of Posterior Lumbar Interbody Fusion with the Expandable Stand-alone Cage (Tyche(R) Cage) for Degenerative Lumbar Spinal Disorders. J Korean Neurosurg Soc 42:251257, 2007 Kimura H, Shikata J, Odate S, Soeda T, Yamamura S: Risk factors for cage retropulsion after posterior lumbar interbody fusion: analysis of 1070 cases. Spine (Phila Pa 1976) 37:1164-1169, 2012 Liu E, Yin Q, Guo D: Long-term follow-up study on expandable cage in treatment of degenerative lumbar disc disease. Chinese Journal of Reparative and Reconstructive Surgery 28:540-543, 2014 Morgenstern R, Morgenstern C: Percutaneous Transforaminal Lumbar Interbody Fusion (pTLIF) with a Posterolateral Approach for the Treatment of Denegerative Disk Disease: Feasibility and Preliminary Results. Int J Spine Surg 9:41, 2015
AC C
1.
ACCEPTED MANUSCRIPT
EP
TE D
M AN U
SC
RI PT
Trivino Lopez A, Romo Contreras I, Rubio Gonzalel A, Garcia Garcia J, Hernandez Vaquero D: Lumbar interbody fusion using expansive intersomatic cages. Rev Esp Cir Ortop Traumatol 46:42-46, 2002
AC C
12.
M AN U
SC
RI PT
ACCEPTED MANUSCRIPT
AC C
EP
TE D
Figure 1: Preoperatively, cage markers (arrow) indicate retropulsion of the cage impinging the L5-foramen. After revision surgery (Postoperative), expandable cages with an anterior height of 17mm (at insertion: 12mm) can be seen. With friendly permission from Spontech Medical AG, Stuttgart, Germany.
Figure 2: During insertion, the TLIF cage is only 12mm high. Its anterior height can be increased to 17mm once it is in situ by a 90° degree turn on the blue interior metal component. With friendly permission from Spontech Medical AG, Stuttgart, Germany.
M AN U
SC
RI PT
ACCEPTED MANUSCRIPT
AC C
EP
TE D
Figure 3: Once inserted in the collapsed state (right upper circle), the insertion device (left) is left in place. The upper handle is turned 90° and thereby induces expansion of the anterior portion of the cage (right lower circle). The insertion device can then unscrewed and removed. With friendly permission from Spontech Medical AG, Stuttgart, Germany.
ACCEPTED MANUSCRIPT Table 1: Overview of expandable lumbar interbody fusion devices
8
Triviño López et al. 12 2002 Liu et al., 2014
10
Kale et al., 20177
Alimi et al., 2015
1
Mechanism of expansion
Wenzel Spine, Austin, TX, USA
PLIF
Disc-OTech
Titaniu m
Disc-O-Tech Medical Technologies Ltd., Herzliya, Israel
PLIF
Interior component can be advanced in situ, leading to contentric, mostly anterior widening of cage The cage is inserted in the collapsed state which is a 5mm tube., It expands to up to 15mm
Tyche
Titaniu m
Korea (N/A)
TLIF
LIFEC
Titaniu m
PLIF
N/A
N/A
OrtoMedimatec, Valladolid, Spain China (N/A)
Double expanda able PLIF cages StaXx XD
PEEK
PEEK
Caliber, Rise, Altera
Globus Medical
AC C
EP
Boktor and Verghese, 3 2017
Property
Cannestra et al., 4 2016
Cannestra et al., 4 2016
Cannestra et al., 4 2016
mediallateral expanda ble (MLX™) LATIS
Opticag e
(NuVasi ve, Inc., San Diego, CA) (Globus Medical , Inc., Audubo n, PA) (Interve ntional Spine, Inc., Irvine,
RI PT
Kim et al., 2007
5
Manufacturer
Advancement of a sled within the cage leads to increased lordosis by 4° N/A
SC
Folman et al., 2003
Materi al Titaniu m
M AN U
Barret-Tuck et al., 2 2017
Device name VariLift
Disc replacem ent Unilatera l PLIF
N/A
TLIF
7 to 15mm in situ expansion
PLIF/TLIF
Expansion in situ
Altera: Titanium (external) PEEK, cobalt chromium molybdenium alloy (internal) Titanium alloy
TLIF
Medio-lateral expansion to hexagonal surface
Titanium alloy
TLIF
Expands to square shape
Titanium
TLIF
Expands in situ with a wedge-induced mechanism
N/A
(Spine Wave, Inc., Shelton, CT, United States) Rise, Caliber:: Titanium, PEEK
TE D
Author, year
N/A
ACCEPTED MANUSCRIPT
Morgenstern et al., 11 2015
FLXfit 3D
CA) (Stryker Spine, Allenda le, NJ) Expandi ng Orthop edics, Atlanta, GA 30326 USA
Titanium
TLIF
Hydraulic; Steerable and expandable in situ
Titanium
TLIF
Articulated device for wider footprint
RI PT
AccuLIF
AC C
EP
TE D
M AN U
SC
Cannestra et al., 4 2016
ACCEPTED MANUSCRIPT TLIF - Transforaminal Lumbar Interbody Fusion
AC C
EP
TE D
M AN U
SC
RI PT
PLIF - posterior lumbar interbody fusion