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. 2021 Nov 1;34(9):E522-E530.
doi: 10.1097/BSD.0000000000001228.

Combining Expandable Interbody Cage Technology With a Minimally Invasive Technique to Harvest Iliac Crest Autograft Bone to Optimize Fusion Outcomes in Minimally Invasive Transforaminal Lumbar Interbody Fusion Surgery

Sohrab Virk  1 , Avani S Vaishnav  1 , Evan Sheha  1   2 , Hikari Urakawa  1 , Kosuke Sato  1 , Yahya Othman  3 , Chirag Chaudhary  1 , Ryan Lee  1 , Guang-Ting Cong  4 , Saad Chaudhary  4 , Sheeraz A Qureshi  1   2
Affiliations

Combining Expandable Interbody Cage Technology With a Minimally Invasive Technique to Harvest Iliac Crest Autograft Bone to Optimize Fusion Outcomes in Minimally Invasive Transforaminal Lumbar Interbody Fusion Surgery

Sohrab Virk et al. Clin Spine Surg. .

Abstract

Study design: This was a retrospective cohort review.

Objective: The objective of this study was to determine the rate of fusion associated with an expandable cage and iliac crest bone graft in minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) surgery.

Summary of background data: MI-TLIF is a commonly performed procedure, but challenges inherent in MI-TLIF technique can make achieving an interbody fusion difficult.

Methods: A retrospective review was performed on consecutive patients treated with an MI-TLIF for degenerative lumbar pathology. Patients that completed patient-reported outcome measures and 1-year computed tomography (CT)-scans for fusion analysis were included. Fusion morphology was analyzed by evaluating CT scans for location of bridging trabecular bone in relation to the cage. Patients with bridging bone were considered fused. Preoperative and postoperative health-related quality of life scores were compared. A Kolmogrov-Smirnoff test was used to determine normality of health-related outcome scores. A Friedman 2-way analysis of variance by ranks with pairwise comparisons to determine statistical significance of differences between the date of a follow-up examination and preoperative examination was done.

Results: Of 75 patients evaluated 23 patients were excluded due to loss to follow-up, adjacent segment degeneration, inability to obtain a CT scan, or reoperation for nonfusion related symptoms. Of 61 disk spaces that were included, 55 had bridging bone through the intervertebral cage, resulting in an overall fusion rate of 90.2%. There was a higher rate of fusion at L5-S1 as compared to L4-L5. There was mean improvement in patient-reported outcome measures for Oswestry Disability Index, Short Form-12 Physical Component Score, Visual Analog Scale Back/Leg pain, and Patient-Reported Outcome Measurement Information System Physical Function. There were no complications associated with iliac crest bone graft harvesting.

Conclusion: Combining an expandable cage with iliac crest autograft bone harvested through a minimally invasive technique can allow for improved fusion rates without graft-site complications in MI-TLIF surgery.

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Conflict of interest statement

S.C.: Speakers fees: Globus Medical Inc., Stryker; Editorial/Governing board: Global Spine Journal, OrthopaedicsOn; Board/Committee member: North American Spine Society, ACSS. S.A.Q.: Consulting: Paradigm Spine, Globus Medical Inc., Stryker K2M; Royalties: Globus Medical Inc., Stryker K2M; Ownership interest: Avaz Surgical, Vital 5 (past relationship); Scientific Advisory Board/Other Office: Association of Bone and Joint Surgeons, Cervical Spine Research, Contemporary Spine Surgery, Healthgrades, International Society for the Advancement of Spine Surgery, LifeLink.com Inc., Minimally Invasive Spine Surgery Group, Minimally Invasive Spine Study Group, North American Spine Society, Simplify Medical, Inc., Society of Minimally Invasive Spine Surgery, Spinal Simplicity, LLC; Editorial Board: Annals of Translational Medicine, Global Spine Journal, Journal of American Academy of Orthopaedic Surgeons, Spine, The Spine Journal; Honoraria: AMOpportunities, RTI Surgical Inc.; Speakers fees: Globus Medical Inc. The remaining authors declare no conflict of interest.

References

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    1. Goldstein CL, Phillips FM, Rampersaud YR. Comparative effectiveness and economic evaluations of open versus minimally invasive posterior or transforaminal lumbar interbody fusion: a systematic review. Spine. 2016;41(suppl 8):S74–S89.
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    1. Mok JK, Gang CH, Qureshi S, et al. Using minimally invasive techniques adds to the value equation for select patients. J Spine Surg. 2019;5:S101–S107.

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