Lateral Lumbar Interbody Fusion Using Expandable vs Static Titanium Interbody Cages: A Prospective Cohort Study of Clinical and Radiographic Outcomes

Int J Spine Surg. 2023 Apr;17(2):265-275. doi: 10.14444/8422. Epub 2023 Mar 8.


Background: Expandable cages are a recent development employed to reduce subsidence and improve fusion compared with static cages as they alleviate the need for repeated trialing or overdistraction of the disc space. This study aimed to compare the radiographic and clinical outcomes in patients undergoing lateral lumbar interbody fusion (LLIF) with either an expandable or static titanium cage.

Methods: This was a prospective study of 98 consecutive patients undergoing LLIF performed over a 2-year period, with the first 50 patients receiving static cages and the following 48 receiving expandable cages. Radiographic evaluation included interbody fusion status, cage subsidence, and change in segmental lordosis and disc height. Clinical evaluation assessed patient-reported outcome measures (PROMs), including the Oswestry Disability Index, visual analog scale (VAS) for back and leg pain, and short form-12 physical and mental health survey scores collected at 3, 6, and 12 months postoperatively.

Results: The 98 patients had 169 cages impacted (84 expandable vs 85 static). Mean age was 69.2 years, and 53.1% were women. There was no significant difference between the 2 groups in terms of age, gender, body mass index, or smoking status. The expandable cage group had higher rates of interbody fusion (94.0% vs 82.9%, P = 0.039) at 12 months as well as significantly reduced implant subsidence rates at all follow-up timepoints (4% vs 18% at 3 months; 4% vs 20% at 6 and 12 months). Patients from the expandable cage group showed a mean 1.9 more points of reduction in VAS back pain (P = 0.006) and 2.49 points greater reduction in VAS leg pain (P = 0.023) at 12-month follow-up.

Conclusions: Expandable lateral interbody spacers resulted in significantly improved fusion rates with reduced subsidence risks and statistically significant improvement in PROMs up to 12 months postoperatively compared with impacted lateral static cages.

Clinical relevance: The data provide clinical relevance in favoring expandable cages over static cages for enhanced fusion outcomes in lumbar fusions.

Keywords: expandable cage; fusion rate; lateral Lumbar interbody fusion; radiographic outcomes; spine surgery; subsidence.