Transforaminal Lumbar Interbody Fusion (TLIF) with Expandable Banana-Shaped Interbody Spacers—Institutional 5-Year Experience

TL;DR

This study examines the safety and effectiveness of using expandable titanium spacers in TLIF surgeries over five years, showing good clinical outcomes and successful spine alignment.

Contribution

The study provides a large single-center experience with expandable TLIF spacers, highlighting their safety and effectiveness in restoring spinal alignment.

Findings

74.1% of patients had good or excellent clinical outcomes at 3 months, and 71.8% at 12 months.

Radiographic fusion was achieved in 73.1% of segments at 12 months with significant improvement in segmental lordosis.

No device failures or device-associated complications were observed during the follow-up period.

Abstract

Background: Transforaminal lumbar interbody fusion (TLIF) with static cages is a frequently performed procedure. Larger series focusing on the use of expandable TLIF spacers are less common. Methods: This retrospective, single-center observational cohort study reviewed consecutive patients treated by TLIF using expandable titanium interbody implants (ALTERA™, Globus Medical Inc., Audubon, PA, USA) for degenerative pathologies from L2-S1 between 11/2018 and 09/2023. Surgical parameters, adverse events, radiological outcomes (fusion rate, segmental lordosis, spinopelvic parameters), and clinical outcomes were analyzed through a mean postoperative follow-up of 12 months. Results: This study identified 270 patients (mean age 65 years, 50.4% female) who underwent TLIF with expandable interbody spacers at 324 levels. Clinical outcomes were good or excellent in 74.1% of patients at 3 months and 71.8% at 12 months. Radiographic fusion was achieved in 73.1% of assessable segments at 12 months. Segmental lordosis increased significantly from 17.8° preoperatively to 20.0° at 12 months (p < 0.001). Adverse event (AE) rates were acceptable across all timepoints, with no device failures or device-associated complications observed. Conclusions: This study demonstrates that TLIF with expandable titanium interbody implants was safe, associated with high fusion rates, and enabled significant restoration of segmental lordosis that was maintained during follow-up.

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