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  • Expandable TLIF Graft Placement via an Articulating Delivery Arm Facilitates Improved Anterior Graft Placement and Superior Segmental Lordosis

    Final Number:

    Matthew J. McGirt MD; Scott L. Parker MD; Silky Chotai MD; Clinton J. Devin MD

    Study Design:

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2017 Annual Meeting

    Introduction: Transforaminal lumbar interbody fusion (TLIF) is now the most frequently performed method of lumbar arthrodesis in degenerative spine disease. We set out to determine expandable TLIF graft allows for more ventral graft placement, greater foraminal area, and improved segmental lordosis versus static TLIF grafts.

    Methods: Forty-six patients undergoing single-level TLIF were included. Patients composed three cohorts, Fig 1,: 1) straight delivery arm system with static graft(n=14); 2) articulating delivery arm system with static graft(n=16); and 3) expandable TLIF graft via articulating delivery arm(n=16). Degree of segmental lumbar lordosis at fused level and percent anterior location of interbody graft in disc space was assessed radiographically, Fig 2.

    Results: Straight delivery arm-static graft cohort had average of 10.7 degree segmental lordosis at fused level with 54% percent anterior location. Articulating delivery arm-static graft had average of 14.7 degree segmental lordosis with 67% percent anterior location. Articulating delivery arm-expandable graft cohort yielded average of 18.7 degree segmental lordosis with 70% percent anterior location. Use of an articulating arm increased lordosis obtained with static TLIF graft (14.7 degree vs 10.7 degree, p<0.01) while use of expandable vs. static TLIF graft maximized lordosis (18.7 degree vs 14.7 degree, p<0.01), Fig 3. Use of an articulating arm, regardless of graft type, resulted in superior ventral graft placement (p<0.01), Fig 4

    Conclusions: Expandable TLIF graft allows for superior segmental lordosis versus traditional static grafts. This evolution in graft design empowers physicians with the tools to better achieve intraoperative surgical goals during TLIF graft placement.

    Patient Care: Expandable TLIF graft allows for superior segmental lordosis, which potentially might lead to improved spinal alignment and clinical outcomes.

    Learning Objectives: - Use of an articulating arm facilitates increased segmental lordosis and provides superior anterior and midline graft placement. - : Expandable TLIF graft allows for superior segmental lordosis compared to traditional static grafts.


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