Objective Anterior cervical discectomy and fusion (ACDF) with anterior plating is a commonly performed procedure for cervical disc diseases. While the clinical outcomes of most reported multilevel ACDF cases are excellent, symptomatic pseudarthrosis remains a challenge, often requiring revision surgeries. This study aims to present the radiological characteristics of multilevel ACDF constructs, which can be considered during intraoperative management to prevent pseudarthrosis.
Methods This retrospective cohort study included patients who underwent multilevel (3 or 4 levels) ACDF with anterior plating between June 2010 and August 2022. Patients were regularly followed at 4 months, 12 months, and then annually postoperation. Fusion rates and characteristic radiological patterns, such as the formation of bony buttresses underneath the anterior plate, were graded and evaluated.
Results A total of 163 patients were included in the study. Overall fusion rates were 26.38%, 64.34%, and 81.58% at 4-month, 1-year, and the final follow-up, respectively. Nonunions at 4-month follow-up with tightly engaged anterior plate with bony buttress formation were more likely to fuse in the later period (Buttress grade 0 vs. 1; p=0.01, odds ratio [OR], 5.70, Buttress grade 1 vs. >2; p<0.01, OR, 12.00).
Conclusion This study emphasizes the significance of pseudarthrosis following multilevel ACDF. Pseudarthrosis predominantly occurs in the caudal-most segment of the construct, particularly when it terminates at C7. Constructs that are not tightly engaged and lack bony buttress formation in the caudal part of multilevel ACDF are more likely to develop pseudarthrosis.
Objective Biportal endoscopic transforaminal lumbar interbody fusion (BE-TLIF) is an emerging, minimally invasive technique performed under biportal endoscopic guidance. However, concerns regarding cage subsidence and sufficient fusion during BE-TLIF necessitate careful selection of an appropriate interbody cage to improve surgical outcomes. This study compared the fusion rate, subsidence, and other radiographic parameters according to the material and size of the cages used in BE-TLIF.
Methods In this retrospective cohort study, patients who underwent single-segment BE-TLIF between April 2019 and February 2023 were divided into 3 groups: group A, regular-sized three-dimensionally (3D)-printed titanium cages; group B, regular-sized polyetheretherketone cages; and group C, large-sized 3D-printed titanium cages. Radiographic parameters, including lumbar lordosis, segmental lordosis, anterior and posterior disc heights, disc angle, and foraminal height, were measured before and after surgery. The fusion rate and severity of cage subsidence were compared between the groups.
Results No significant differences were noted in the demographic data or radiographic parameters between the groups. The fusion rate on 1-year postoperative computed tomography was comparable between the groups. The cage subsidence rate was significantly lower in group C than in group A (41.9% vs. 16.7%, p=0.044). The severity of cage subsidence was significantly lower in group C (0.93±0.83) than in groups A (2.20±1.84, p=0.004) and B (1.79±1.47, p=0.048).
Conclusion Cage materials did not affect the 1-year postoperative outcomes of BE-TLIF; however, subsidence was markedly reduced in large cages. Larger cages may provide more stable postoperative segments.
Citations
Citations to this article as recorded by
Development and Validation of a Predictive Model and Web-Based Calculator for Cage Subsidence After Midline Lumbar Interbody Fusion (MIDLIF) Surgery Mingzheng Zhao, Honghao Yang, Shixuan Guo, Jun Miao, Zepei Zhang, Yangpu Zhang, Kuan Li, Fengqi Cheng, Jing Su, Yaoshen Zhang, Yong Hai, Yuzeng Liu Global Spine Journal.2026; 16(3): 1423. CrossRef
Influence of surgical technique, interbody characteristics, and radiographic parameters on fusion rates across the disc space and posterolateral elements following transforaminal lumbar interbody fusion Zach Pennington, Abdelrahman Hamouda, Omar Hafz, Anthony L. Mikula, Michelle J. Clarke, William E. Krauss, Brett A. Freedman, Melvin D. Helgeson, Ahmad N. Nassr, Arjun S. Sebastian, Jeremy L. Fogelson, Benjamin D. Elder Clinical Neurology and Neurosurgery.2026; 261: 109285. CrossRef
Sagittal Alignment and Clinical Outcomes After Biportal Endoscopic Transforaminal Lumbar Interbody Fusion Using a Single Expandable Cage: One Year Follow-up Sub-Ri Park, Namhoo Kim, Ji-Won Kwon, Kyung-Soo Suk, Hak-Sun Kim, Seong-Hwan Moon, Si-Young Park, Byung Ho Lee, Jae-Won Shin, Jin-Oh Park World Neurosurgery.2026; 205: 124698. CrossRef
Advancements in unilateral biportal endoscopic lumbar interbody fusion: a narrative review Penghui Lv, Lu Li, Sichao Cheng, Jincheng Bai, Jianjun Chang European Journal of Medical Research.2026;[Epub] CrossRef
A Review of Synthetic Bone Grafts in Lumbar Interbody Fusion Jaden Wise, Isabella Merem, Dahlia Wrubluski, Xuanzong Zhang, Ridge Weston, Min Shi, Maohua Lin, Frank D. Vrionis Bioengineering.2026; 13(3): 262. CrossRef
Clinical and radiologic outcomes of expandable versus static cages in biportal endoscopic TLIF: focus on endplate injury and subsidence Tae Hoon Kang, Geumho Lee, Byungjun Kang, Jeongwoon Han, Hyun-jin Park, Minjoon Cho, Jae Hyup Lee Journal of Orthopaedic Surgery and Research.2026;[Epub] CrossRef
En bloc discectomy via anterior lumbar approach: a technical note Harmantya Mahadhipta, Amri Muhyi, Muhamad Abdul Harist Fadhlizain, Mitchel Mitchel, Karina Sylvana Gani, Erica Kholinne SICOT-J.2026; 12: 19. CrossRef
Clinical outcomes and radiologic parameters of percutaneous endoscopic posterior/transforaminal lumbar interbody fusion using rammed-earth technique Qingyang Kang, Zhilin Ge, Jiheng Zhan, Xuzhou Li, Guanwei Huang, Guoyi Su Frontiers in Surgery.2026;[Epub] CrossRef
Titanium-coated PEEK versus 3D-printed porous titanium cages in transforaminal lumbar interbody fusion: A meta-analysis Youngmin Yu, Thomas Cho, Jiayong Liu Journal of Orthopaedics.2026; 77: 124. CrossRef
Clinical and radiological outcomes following biportal endoscopic lumbar interbody fusion: A comparative study of three interbody cage strategies Ju-Eun Kim, Hee Soo Kim, Daniel K. Park World Neurosurgery: X.2026; 31: 100604. CrossRef
Clinical and Radiological Outcomes of Double-Cage Full Endoscopic Transforaminal Lumbar Interbody Fusion Compared with Posterior Lumbar Interbody Fusion : A Retrospective Cohort Study Chi Ho Kim, Pius Kim, Chang Il Ju, Jong Hun Seo Journal of Korean Neurosurgical Society.2026; 69(4): 596. CrossRef
Preoperative coronal magnetic resonance imaging: a critical evaluation of the Kambin’s triangle for the transforaminal lumbar interbody fusion procedure Koopong Siribumrungwong, Bunyaporn Wuttiworawanit, Punnawit Pinitchanon, Chanon Chiarnpattanodom, Thongchai Suntharapa Asian Spine Journal.2026;[Epub] CrossRef
Impact of endplate–graft geometric matching on cage subsidence following stand-alone lateral lumbar interbody fusion: a finite element analysis Youchen Ye, Hao Li, Fangcai Li BMC Musculoskeletal Disorders.2026;[Epub] CrossRef
3D-printed porous titanium vs polyetheretherketone cages in lumbar interbody fusion: a prospective, multicenter, randomized controlled trial with bone mineral density stratification Jae-Won Shin, Mun-Su Park, Ji-Won Kwon, Sang-Ho Kim, Joonoh Seo, Hak-Sun Kim, Kyung-Soo Suk, Seong Hwan Moon, Si-Young Park, Byung Ho Lee The Spine Journal.2026;[Epub] CrossRef
Technical Feasibility and Early Outcomes of Minimally Invasive Transforaminal Lumbar Interbody Fusion with Large-Footprint Cage via Tubular Approach: A Novel Surgical Technique Ayush Sharma, Shubham Kadam, Nandan Marathe, Avi Rangala, Sourav L. Das, Ajit Rampure Asian Journal of Neurosurgery.2026;[Epub] CrossRef
Biportal Endoscopic Lumbar Interbody Fusion With 3D Printed Double Cage Ju-Eun Kim, Hee-Soo Kim, Sung Choi, Daniel K. Park Clinical Spine Surgery.2026;[Epub] CrossRef
Are Ceramic Cages an Option for Lumbar Interbody Fusion? A Comparative Biomechanical Numerical Study Davide Ninarello, Luigi La Barbera JOR SPINE.2026;[Epub] CrossRef
Risk factors influencing cage retropulsion following lumbar interbody fusion in treating degenerative lumbar diseases: A comprehensive systematic review and meta-analysis Yong Liu, Hongyu Chen, Xiaoming Hu, Xiaokun Wu, Xiangui Yu, Hai Chen, Wenxiong Zhang, Limin Du Journal of Orthopaedic Science.2025; 30(5): 768. CrossRef
Anterior Lumbar Interbody Fusion (ALIF) Versus Full-Endoscopic/Percutaneous TLIF With a Large-Footprint Interbody Cage: A Comparative Observational Study Christian Morgenstern, Francisco Nogueras, Geoffrey Delbos, Rudolf Morgenstern Global Spine Journal.2025; 15(6): 2910. CrossRef
Goutallier grading of psoas major and lumbar extensor muscles as a predictor of cage subsidence and reoperation following transforaminal and posterior lumbar interbody fusion Frank Vazquez, Alex Tang, Ara Khoylyan, Tan Chen The Spine Journal.2025; 25(11): 2514. CrossRef
In vitro comparison of endplate preparation in biportal endoscopic and microscopic tubular transforaminal lumbar interbody fusion procedures Min-Seok Kang, Samuel K. Cho, Samuel Q. Li, Fady Y. Hijji, Jun S. Kim, Sang-Min Park, Ki-Han You, Hyun-Jin Park The Spine Journal.2025; 25(10): 2326. CrossRef
Development and internal validation of a risk score for subsidence of expandable spacers in transforaminal lumbar interbody fusion (TLIF) surgery Martin N. Stienen, Lorenzo Bertulli, Linda Bättig, Yesim Yildiz, Gregor Fischer, Laurin Feuerstein, Francis Kissling, Thomas Schöfl, Felix C. Stengel, Felix Corr, Silvio Heinig, Nader Hejrati, Daniele Gianoli, Stefan Motov, Michael Betz, Benjamin Martens Brain and Spine.2025; 5: 104322. CrossRef
Novel Unilateral Biportal Endoscopy-Assisted Lumbar Fusion With Dual Hybrid Cage Insertion: A Technical Note With Case Presentation Jisoo Ha, Kuldeep Bansal, Chang-Wook Kim, Do-Hyoung Kim, Shreenidhi Kulkarni, Hee-Don Han Journal of Minimally Invasive Spine Surgery and Technique.2025; 10(2): 230. CrossRef
A Novel Switching Portal Technique in Biportal Endoscopic Transforaminal Lumbar Interbody Fusion: Technical Notes and Comparative Outcomes Yun-Da Li, Chi-An Luo, Yung-Hsueh Hu, Wen-Chien Chen, Tsung-Ting Tsai, Po-Liang Lai, Tsai-Sheng Fu World Neurosurgery.2025; 203: 124511. CrossRef
Biportal Endoscopic Lumbar Interbody Fusion Using the Oblique Lumbar Interbody Fusion Cage: Technical Note and Case Illustration Tran Vu Hoang Duong, Phan Quang Son, Le Tan Bao, Luc Dinh Phuong, Phan Dinh Thanh Journal of Minimally Invasive Spine Surgery and Technique.2025; 10(2): 303. CrossRef
Anterior Cervical Discectomy and Fusion Using Cages With Different Sized Windows Chengkun Zhao, Shijie Wang, Jingjing Zhang, Hegang Niu, Yun Cao, Hui Tao, Cailiang Shen, Yinshun Zhang Spine.2025; 50(22): 1556. CrossRef
Comparative Clinical and Radiological Outcomes of Banana-Shaped Versus Straight Cages in Biportal Endoscopic Transforaminal Lumbar Interbody Fusion: A Retrospective Cohort Study Nguyen Ngoc Thoi, Nguyen Le Hoang Tuan, Le Tuong Vien, Nguyen Thanh Nhan, Hoang Nguyen Anh Tuan, Nguyen Van Thanh, Tran Nguyen Phuong, Bui Hong Thien Khanh Journal of Minimally Invasive Spine Surgery and Technique.2025; 10(2): 172. CrossRef
Radiographic Analysis of Endplate Coverage of a 3-Dimensional-Expandable Transforaminal Lumbar Interbody Fusion (TLIF) Implant Compared to Static TLIF and Anterior Lumbar Interbody Fusion Implants Jacob Mazza, Manhal Siddiqi, John Paul G. Kolcun, Dominick Richards, Richard G. Fessler Neurospine.2025; 22(4): 891. CrossRef
Objective Three-dimensional (3D)-printed titanium implants have been developed recently, but the utility is not yet proven. The aim of this study was to compare 3D-printed titanium and polyetheretherketone (PEEK) implants after minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF).
Methods Between October 2018 and September 2021, we retrospectively analyzed 83 patients who underwent single-level MIS-TLIF (3D-printed titanium, 40; PEEK, 43). Radiologic parameters were assessed with x-ray and computed tomography (CT) at postoperative 1 week, 6 months, and 1 year. Clinical status was evaluated using Oswestry Disability Index, visual analogue scale score, and Bridwell fusion grading was assessed on 6-month and 1-year postoperative CT.
Results There were no differences between the 2 groups in demographics and clinical outcomes. At 1-year of follow-up, the reported 3D-printed titanium fusion grades were grade I: 77.5% (31 patients), grade II: 17.5% (7 patients), and grade III: 5% (2 patients). The PEEK fusion grades were grade I: 51.2% (22 patients), grade II: 41.9% (18 patients), and grade III: 7.0% (3 patients). For overall fusion rate (grade I + II), there was no difference between the 2 cages (95.0% vs. 93.0%, p = 0.705), but grade I was reported at a higher incidence in 3D-printed titanium than PEEK (77.5% vs. 51.2%, p = 0.013). There was no difference between cages based on subsidence and complications.
Conclusion There were no significant differences in the overall fusion rate for MIS-TLIF surgery between 3D-printed titanium and PEEK, but the fusion grade was better in 3D-printed titanium than in PEEK. Long-term follow-up is required to verify the effectiveness.
Citations
Citations to this article as recorded by
Do Three-Dimensional Printed Porous Titanium Relative to Polyetheretherketone Interbody Cages Reduce Complications and Revisions after Transforaminal Lumbar Interbody Fusion? Hannah A. Levy, Abdelrahman M. Hamouda, Christopher A. Magera, Jayanth Kumar, Cassandra Willson, Brian C. Goh, James T. Bernatz, Benjamin D. Elder, Brett A. Freedman, Arjun S. Sebastian Global Spine Journal.2026; 16(1): 185. CrossRef
Lumbar Fusion With Micro- & Nano-Textured, 3D Printed Porous Titanium Versus PEEK Interbody Cages in TLIF: A Single-Blinded, Randomized Controlled Trial Joshua H. Weinberg, Nathan Ritchey, Witty Kwok, Shravani Khisti, Bryan Ladd, Stephanus Viljoen, Siri S. Khalsa, David S. Xu, Andrew J. Grossbach Global Spine Journal.2026; 16(1): 434. CrossRef
Evaluation of the porosity and structural stability of 3D-printed porous titanium pedicle screws using finite element analysis Kwang Hyeon Kim, Junsu Bae, Kyeong-Joo Yoo, Seonghoon Jeong, Byung-Jou Lee Biomedical Engineering Letters.2026; 16(1): 55. CrossRef
Three-Dimensional Printing of a Spinal Interbody: Design Principles, Biomaterials, and Translational Considerations Sahil Garg, Patrick Young, Christopher Franquemont, Rachel Conley, Sanjitpal Gill Journal of Functional Biomaterials.2026; 17(3): 143. CrossRef
Optimal cage biomaterials for fusion and subsidence outcomes in lumbar spinal fusion: a network meta-analysis of 4881 patients Gilberto Perez Rodriguez Garcia, James Kelbert, Dana Saleh, Annemarie Pico, Nikhil Dholaria, Giovanni Barbagli, Zachary Wetsel, Salma Bakr, Tyler Krall, Vick Sahni, Amna Hussein, Joseph Georges, Sananthan Sivakanthan, Michael Prim, Ali A. Baaj European Spine Journal.2026;[Epub] CrossRef
Titanium-coated PEEK versus 3D-printed porous titanium cages in transforaminal lumbar interbody fusion: A meta-analysis Youngmin Yu, Thomas Cho, Jiayong Liu Journal of Orthopaedics.2026; 77: 124. CrossRef
Mechanical optimization of 3D-printed PEEK spinal fusion cages: An integrated experimental–computational framework Gabriela Talpeanu, David Putzer, Ran Wang, Fatemeh Shahriyari, Michael Nogler, Timothy O.’Brian, Firas Awaja Materials Today Communications.2026; 54: 115512. CrossRef
3D-printed porous titanium vs polyetheretherketone cages in lumbar interbody fusion: a prospective, multicenter, randomized controlled trial with bone mineral density stratification Jae-Won Shin, Mun-Su Park, Ji-Won Kwon, Sang-Ho Kim, Joonoh Seo, Hak-Sun Kim, Kyung-Soo Suk, Seong Hwan Moon, Si-Young Park, Byung Ho Lee The Spine Journal.2026;[Epub] CrossRef
Trabecular Bone Remodeling after Posterior Lumbar Interbody Fusion: Comparison of the Osseointegration in Three-Dimensional Porous Titanium Cages and Polyether-Ether-Ketone Cages Naoki Segi, Hiroaki Nakashima, Sadayuki Ito, Jun Ouchida, Ryotaro Oishi, Ippei Yamauchi, Yuichi Miyairi, Yoshinori Morita, Tomohiro Matsumoto, Shunsuke Kanbara, Keigo Ito, Shiro Imagama Global Spine Journal.2025; 15(1): 66. CrossRef
A comprehensive review on the State of the Art in the research and development of poly-ether-ether-ketone (PEEK) biomaterial-based implants Prabaha Sikder Acta Biomaterialia.2025; 191: 29. CrossRef
Evaluation of Healthcare Outcomes of Patients Treated with 3D-Printed-Titanium and PEEK Cages During Fusion Procedures in the Lumbar Spine Katherine Corso, Andreas Teferra, Annalisa Michielli, Kristin Corrado, Amy Marcini, Mark Lotito, Caroline Smith, Michelle Costa, Jill Ruppenkamp, Anna Wallace Medical Devices: Evidence and Research.2025; Volume 18: 37. CrossRef
3D Printed Titanium Scaffolds with Bi‐Directional Gradient QK‐Functionalized Surface Xiaoyun Sun, Ru Zhong, Congcong Wu, Silin Ye, Haipeng Yuan, Zhou Fang, Junjian Chen, Delin Cheng, Lijing Hao, Lei Chu, Lin Wang Advanced Materials.2025;[Epub] CrossRef
Clinical and radiological outcomes of titanium cage versus polyetheretherketone cage in lumbar interbody fusion: a systematic review and meta-analysis Haozhong Wang, Hao Zhang, Changming Xiao, Kaiquan Zhang, Lisheng Qi Neurosurgical Review.2025;[Epub] CrossRef
Clinical and radiological outcomes of posterior lumbar interbody fusion with titanium cage Ehab A.E. Elshal, Amer A. Mostafa, Mohammed A.E.B.A. Elfattah Al-Azhar Assiut Medical Journal.2025; 23(1): 1. CrossRef
Advancements in biomaterials and bioactive solutions for lumbar spine fusion cages: Current trends and future perspectives Iulian Antoniac, Veronica Manescu (Paltanea), Gheorghe Paltanea, Aurora Antoniac, Marco Fosca, Dan Laptoiu, Julietta V. Rau Bioactive Materials.2025; 53: 656. CrossRef
Comparative Analysis Between Single and Double 3-Dimensional Printed Titanium Cages: 1-Year Outcomes After Unilateral Biportal Endoscopic Transforaminal Lumbar Interbody Fusion Ji Yeon Kim, Jin Hong Hyun, Su Yong Choi, Dong Chan Lee, Hyeun Sung Kim, Dong Hwa Heo Journal of Minimally Invasive Spine Surgery and Technique.2025; 10(Suppl 2): S225. CrossRef
Current Applications and Future Directions of Technologies Used in Adult Deformity Surgery for Personalized Alignment: A Narrative Review Janet Hsu, Taikhoom M. Dahodwala, Noel O. Akioyamen, Evan Mostafa, Rami Z. AbuQubo, Xiuyi Alexander Yang, Priya K. Singh, Daniel C. Berman, Rafael De la Garza Ramos, Yaroslav Gelfand, Saikiran G. Murthy, Jonathan D. Krystal, Ananth S. Eleswarapu, Mitchell Journal of Personalized Medicine.2025; 15(10): 480. CrossRef
Expandable Cage in Minimally Invasive Transforaminal Lumbar Interbody Fusion: Comparative Data with Static Cage from a Single Institution and a Single Surgeon Dongkyu Kim, Hyun Jun Jang, Bong Ju Moon, Kyung Hyun Kim, Sung Uk Kuh, Dong Kyu Chin, Keun Su Kim, Jeong Yoon Park World Neurosurgery.2025; 202: 124428. CrossRef
Comparative Evaluation of PEEK, 3D-Printed Titanium Mesh and Solid Titanium Implants on HU Distortion and Dose Calculation Accuracy in Radiotherapy Sook Yang, Euncheol Choi, Seung Gyu Park, Byungyong Kim, Ye Won Kim, Myeongsoo Kim Applied Sciences.2025; 15(20): 11264. CrossRef
Is Ti-Coated PEEK Superior to PEEK for Lumbar and Cervical Fusion Procedures? A Systematic Review and Meta-Analysis Julia Kincaid, Richelle J. Kim, Akash Verma, Ryan W. Turlip, David D. Liu, Daksh Chauhan, Mert Marcel Dagli, Richard J. Chung, Hasan S. Ahmad, Yohannes Ghenbot, Ben Gu, Jang Won Yoon Journal of Clinical Medicine.2025; 14(21): 7696. CrossRef
Comparison of Lumbar Interbody Fusion with 3D-Printed Porous Titanium Cage Versus Polyetheretherketone Cage in Treating Lumbar Degenerative Disease: A Systematic Review and Meta-Analysis Yuchen Duan, Dagang Feng, Tong Li, Yiran Wang, Leiming Jiang, Yong Huang World Neurosurgery.2024; 183: 144. CrossRef
Expandable Cages for Lumbar Interbody Fusion: A Narrative Review Soo-Bin Lee, Jonghun Yoon, Sung-Jun Park, Dong-Sik Chae Journal of Clinical Medicine.2024; 13(10): 2889. CrossRef
A comparison of transforaminal lumbar interbody fusion (TLIF) cage material on fusion rates: A systematic review and network meta-analysis Sutipat Pairojboriboon, Supranee Niruthisard, Chandhanarat Chandhanayingyong, Chalinee Monsereenusorn, Siwaporn Poopan, Sheng-Fu Larry Lo World Neurosurgery: X.2024; 23: 100392. CrossRef
Evolution of Titanium Interbody Cages and Current Uses of 3D Printed Titanium in Spine Fusion Surgery Justin J. Lee, Freddy P. Jacome, David M. Hiltzik, Manasa S. Pagadala, Wellington K. Hsu Current Reviews in Musculoskeletal Medicine.2024; 18(12): 635. CrossRef
Effect of Cage Material and Size on Fusion Rate and Subsidence Following Biportal Endoscopic Transforaminal Lumbar Interbody Fusion Ki-Han You, Samuel K. Cho, Jae-Yeun Hwang, Sun-Ho Cha, Min-Seok Kang, Sang-Min Park, Hyun-Jin Park Neurospine.2024; 21(3): 973. CrossRef
Postoperative urinary retention after oblique lumbar interbody fusion under the systematic management protocol Joonsoo Lim, Jangyeob Lim, Asfandyar Khan, Chang-Hyun Lee, Jun-Hoe Kim, Sejin Choi, Tae-Shin Kim, Yunhee Choi, Chun Kee Chung, Sangwook T. Yoon, Kyoung-Tae Kim, Chi Heon Kim Scientific Reports.2024;[Epub] CrossRef
Concentration-Dependent Efficacy of Recombinant Human Bone Morphogenetic Protein-2 Using a HA/β-TCP Hydrogel Carrier in a Mini-Pig Vertebral Oblique Lateral Interbody Fusion Model Hye-Yeong Lee, Ji-In Kang, Hye-Lan Lee, Gwang-Yong Hwang, Keung-Nyun Kim, Yoon Ha International Journal of Molecular Sciences.2023; 24(1): 892. CrossRef
Anterior and Posterior Approaches for 4-Level Degenerative Cervical Myelopathy: Low-Profile Cage Versus Cervical Pedicle Screws Fixation Peng Zou, Rui Zhang, Jun-Song Yang, Er-Liang Li, Qian Zhang, Yuan-Ting Zhao Journal of Clinical Medicine.2023; 12(2): 564. CrossRef
Spinal Canal Remodeling and Indirect Decompression of Contralateral Foraminal Stenosis After Endoscopic Posterolateral Transforaminal Lumbar Interbody Fusion Pang Hung Wu, Eugene Tze-Chun Lau, Hyeun-Sung Kim, Giovanni Grasso, Il-Tae Jang Neurospine.2023; 20(1): 99. CrossRef
Commentary on “Three-Dimensional-Printed Titanium Versus Polyetheretherketone Cages for Lumbar Interbody Fusion: A Systematic Review of Comparative In Vitro, Animal, and Human Studies” Yanting Liu, Siravich Suvithayasiri, Jin-Sung Kim Neurospine.2023; 20(2): 464. CrossRef
Clinical and Radiologic Outcomes of Biportal Endoscopic Lumbar Interbody Fusion With a Long Polyetheretherketone Cage Cheol Woong Park, A. Muhammed Anzar, Beom Seok Yoo, Jae Eon Yoon, Jae Hyun Kim, Woo Min Park Journal of Minimally Invasive Spine Surgery and Technique.2023; 8(Suppl 1): S62. CrossRef
Comparison between Three‐Dimensional Printed Titanium and PEEK Cages for Cervical and Lumbar Interbody Fusion: A Prospective Controlled Trial Zhipeng Deng, Qiang Zou, Lei Wang, Liang Wang, Peng Xiu, Ganjun Feng, Yueming Song, Xi Yang Orthopaedic Surgery.2023; 15(11): 2889. CrossRef
Saving Stabilizing Structure Treatment With Bilateral-Contralateral Decompression for Spinal Stenosis in Degenerative Spondylolisthesis Using Unilateral Biportal Endoscopy Dong Hyun Lee, Dong-Geun Lee, Choon Keun Park, Jae-Won Jang, Jin Sub Hwang, Jun Yong Kim, Yong-Eun Cho, Sang Won Lee, Dong Chan Lee, Bang Sang Han, Sang Yeop Han Neurospine.2023; 20(3): 931. CrossRef
Comparative Analysis of Radiologic Outcomes Between Polyetheretherketone and Three-Dimensional-Printed Titanium Cages After Transforaminal Lumbar Interbody Fusion Tamima Sultana, Mosharraf Hossain, Je Hoon Jeong, Soobin Im World Neurosurgery.2023; 179: e241. CrossRef
The Endoscopic Lumbar Interbody Fusion: A Narrative Review, and Future Perspective Phattareeya Pholprajug, Vit Kotheeranurak, Yanting Liu, Jin-Sung Kim Neurospine.2023; 20(4): 1224. CrossRef
Fusion Assessment of Oblique Lumbar Interbody Fusion Using Demineralized Bone Matrix: A 2-Year Prospective Study Sangseok Lee, Jin Woo Jung, Sang-Woo Lee, Kyoung-Tae Kim, Heum-Dai Kwon, Subum Lee, Young San Ko, Pius Kim, Dae-Chul Cho Neurospine.2023; 20(4): 1205. CrossRef
The Combined Effects of RhBMP-2 and Systemic RANKL Inhibitor in Patients With Bone Density Loss Undergoing Posterior Lumbar Interbody Fusion: A Retrospective Observational Analysis With Propensity Score Matching Seungjun Ryu, Seon-Jin Yoon, Chang Kyu Lee, Seong Yi, Keung-Nyun Kim, Yoon Ha, Dong Ah Shin Neurospine.2023; 20(4): 1186. CrossRef
Objective Midline lumbar interbody fusion is performed for treatment of various lumbar degenerative diseases, with good clinical outcomes and few complications. However, there are no large-scale or long-term studies regarding midline lumbar interbody fusion. Therefore, the purpose of this study was to evaluate the clinical results of midline lumbar interbody fusion and to compare the results according to surgical level.
Methods Between January 2013 and December 2015, 200 patients with lumbar degenerative disease undergoing midline lumbar interbody fusion surgery were enrolled. The mean patient age was 69.9 ± 15.8 years (range, 40–85 years). The patients were divided into groups according to surgical level: (1) level 1 operation (136 patients), (2) level 2 operation (43 patients), (3) level 3 operation (12 patients), and (4) level 4 or higher (9 patients). Clinical outcomes, fusion rates, and complications were compared among the 4 groups.
Results All clinical outcomes significantly improved after surgery (measured at 3 years postoperatively) in all groups. Mean fusion rate was 90.5% ± 5.21%. Fusion rate was highest in group I (95.8%) and lowest in group IV (85.2%). There were complications in 17 cases (8.5%). Adjacent segment disease occurred in 16 cases, 5 of which required surgery. Group 1 had 1 case, and group 4 had 4 cases. Screw loosening occurred in 1 case in group 4. There were no cases of infection or mechanical complications.
Conclusion This large, single‐institution, retrospective study demonstrates favorable clinical outcomes after midline lumbar interbody fusion for lumbar degenerative disease regardless of surgical level.
Citations
Citations to this article as recorded by
Open Midline Decompression with Ligament Reconstruction for Multiple-Level Spinal Stenosis in Elderly Patients Shin-Jae Kim, Sang-Ho Lee, Junseok Bae NeuroSci.2025; 6(1): 18. CrossRef
Surgical stabilization for degenerative lesions of the lumbar spine in patients with reduced bone mineral density: a systematic literature review I. V. Shirokikh, A. I. Vasilyev, Yu. M. Batrak, V. A. Peleganchuk Russian Journal of Spine Surgery (Khirurgiya Pozvonochnika).2024; 21(1): 44. CrossRef
Postoperative urinary retention after oblique lumbar interbody fusion under the systematic management protocol Joonsoo Lim, Jangyeob Lim, Asfandyar Khan, Chang-Hyun Lee, Jun-Hoe Kim, Sejin Choi, Tae-Shin Kim, Yunhee Choi, Chun Kee Chung, Sangwook T. Yoon, Kyoung-Tae Kim, Chi Heon Kim Scientific Reports.2024;[Epub] CrossRef
Comparison of Cortical Bone Trajectory to Pedicle-Based Dynamic Stabilization: An Analysis of 291 Patients Chih-Chang Chang, Hsuan-Kan Chang, Chin-Chu Ko, Ching-Lan Wu, Yi-Hsuan Kuo, Tsung-Hsi Tu, Wen-Cheng Huang, Jau-Ching Wu Neurospine.2023; 20(1): 308. CrossRef
The Fusion Rate of Cortical Bone Trajectory Screw Fixation and Pedicle Screw Fixations in L4‐5 Interbody Fusion: A Retrospective Cohort Study Yuhe Lin, Jie Xu, Wu Zheng Orthopaedic Surgery.2023; 15(5): 1281. CrossRef
Minimally invasive fusion surgery for patients with degenerative spondylolisthesis and severe lumbar spinal stenosis: a comparative study between MIDLIF and TLIF Pedro Santos Silva, Ana Jardim, Joana Pereira, Rita Sousa, Rui Vaz, Paulo Pereira European Spine Journal.2023; 32(9): 3210. CrossRef
Cortical bone trajectory screws in the treatment of lumbar degenerative disc disease in patients with osteoporosis Song Guo, Kai Zhu, Mei-Jun Yan, Xin-Hua Li, Jun Tan World Journal of Clinical Cases.2022; 10(36): 13179. CrossRef
First
Prev
