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
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.