PT  - JOURNAL ARTICLE
AU  - Malham, Gregory M.
AU  - Blecher, Carl M.
AU  - Munday, Nigel R.
AU  - Hamer, Ryan P.
TI  - Expandable Lateral Lumbar Cages With Integrated Fixation: A Viable Option for Rostral Adjacent Segment Disease
AID  - 10.14444/8307
DP  - 2022 Aug 01
TA  - International Journal of Spine Surgery
PG  - 748--759
VI  - 16
IP  - 4
4099  - https://www.ijssurgery.com/content/16/4/748.short
4100  - https://www.ijssurgery.com/content/16/4/748.full
SO  - Int J Spine Surg2022 Aug 01; 16
AB  - Background Adjacent segment disease (ASD) above a previous posterior lumbar instrumented fusion can be managed with minimally invasive lateral lumbar interbody fusion. Earlier procedures with stand-alone lateral cages risked nonunion, and lateral cages with separate lateral plates risked lumbar plexus injury and vertebral fracture. We investigated clinical and radiographic outcomes of an expandable lateral titanium interbody cage with an integrated lateral fixation (eLLIFp) device as a stand-alone treatment for symptomatic ASD above a previous posterior lumbar fusion and performed a comparative cost analysis of eLLIFp to alternative operations for ASD.Methods In this prospective, observational study, patients with ASD above 1-, 2-, 3-, or 4-level instrumented posterior fusions underwent surgery with lateral expandable titanium cage(s) with an integrated lateral plate with single screws into each adjacent vertebra from August 2017 to August 2019. Multimodality intraoperative neural monitoring was performed. Patient-reported outcomes, computed tomography outcomes, and total costs were analyzed.Results A total of 33 patients received 35 eLLIFp cages. All clinical outcomes improved significantly. The eLLIFp cages added 2.2° segmental lordosis and 2.7 mm posterior disc height. Interbody fusion rate was 94% at 12 months. There were 2 neurologic complications (6%): 1 patient reported transient anterior thigh numbness and 1 had mild persistent L4 radiculopathy. No cage subsidence, cage migration, screw loosening, or vertebral fracture occurred. No revision lateral surgery, posterior decompression, or supplemental posterior fixation was required. The total eLLIFp cost (AU$19,715) was lower than the cost for all other procedures.Conclusions eLLIFp provided a minimally invasive, low morbidity, cost-effective, and robust alternative to traditional posterior construct extension surgery for rostral lumbar ASD in selected patients with 1- to 2-level stenosis and minimal deformity.Clinical Relevance Traditional ASD treatment involves substantial risks and expense. eLLIFp should be considered a safe, effective, and lower cost alternative to posterior construct extension surgery.Level of Evidence 2.